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Asking Three Questions May Improve Migraine Care

According to a recent study, using a screening tool that asks if a patient experiences headache disability, nausea, and sensitivity to light can help diagnose migraine and decrease opiate prescriptions.

In the first phase of their research, K.C. Brennan, MD (left), and colleagues at the University of Utah evaluated the records of nearly 17,000 patients who had sought headache treatment in more than 50,000 clinic visits. In more than half of the encounters, only a symptom code (784.0) was provided, and not a diagnosis code. This is troubling, Dr. Brennan said, because relying on a symptom code for headache may reflect practitioner discomfort in diagnosing migraine and other primary headaches. Researchers also found an excessive reliance on opiates, which are not recommended for migraine.

  • In more than 30% of the headache encounters, the patient received opiates.
  • More than 36% of the encounters with migraine diagnostic codes resulted in opiate prescriptions, and slightly more than 19% resulted in triptan prescriptions.
  • Both triptans and opiates were more likely to be prescribed when a migraine was diagnosed rather than providing a headache symptom code.
  • Heavy users of medical services were more likely to be prescribed an opiate and less likely to be prescribed a triptan.

For the next phase of the study, health care professionals used a simple screening tool, which also offered treatment protocols. At the end of 5 weeks, medical records with only headache symptom codes had decreased from 41% to 33%. Additionally, opioid prescriptions decreased dramatically, with a corresponding increase in triptan prescriptions.

Dr. Brennan, who is the director of the Headache Physiology Laboratory at the University of Utah in Salt Lake City, presented these findings at the American Academy of Neurology conference in the spring. He reported that he and his colleagues are trying to expand the use of the tool to other clinics.

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