SAN DIEGO —
It is estimated that about 4 million PCP office visits annually are headache related, and that 52.8% of all migraine encounters occur in primary care settings.
However, PCPs aren’t always adequately trained in headache management and referral times to specialist care can be lengthy.
Data published in Headache show only 564 accredited headache specialists practice in the United States, but at least 3700 headache specialists are needed to treat those affected by migraine, with even more needed to address other disabling headache types such as tension-type headache and cluster headache. To keep up with population growth, it is estimated that the United States will require 4500 headache specialists by 2040.
First Contact
To tackle this specialist shortfall, the AHS developed the First Contact program with the aim of improving headache education in primary care and help alleviate at least some of the demand for specialist care.
The national program was rolled out in 2020 and 2021. The educational symposia were delivered to PCPs at multiple locations across the country. The initiative also included a comprehensive website with numerous support resources.
After participating in the initiative, attendees were surveyed about the value of the program, and the results were subsequently analyzed and presented at the annual meeting of the American Headache Society.
The analysis included 636 survey respondents, a 38% response rate. Almost all participants (96%) were MDs and DOs. The remainder included nurse practitioners, physician assistants, and dentists.
About 85.6% of respondents reported being completely or very confident in their ability to recognize and accurately diagnose headache disorders, and 81.3% said they were completely or very confident in their ability to create tailored treatment plans.
Just over 90% of participants reported they would implement practice changes as a result of the program. The most commonly cited change was the use of diagnostic tools such as the three-question Migraine ID screener, followed closely by consideration of prescribing triptans and reducing the use of unnecessary neuroimaging.
“Overall, there was a positive response to this type of educational programming and interest in ongoing education in addressing headache disorders with both pharmaceutical and non-pharmaceutical treatment options,” said Nisha Malhotra, MD, a resident at New York University (NYU) Langone Health, New York City, who presented the findings at the conference.
The fact that so many general practitioners were keen to use this easy-to-use screen [Migraine ID screener], which can pick up about 90% of people with migraine, is “great,” said study investigator Mia Minen, MD, associate professor and chief of headache research at NYU Langone Health. “I’m pleased primary care providers said they were considering implementing this simple tool.”
However, respondents also cited barriers to change. These included cost constraints (48.9%), insurance reimbursement issues (48.6%), and lack of time (45.3%). Dr. Malhotra noted these concerns are primarily related to workflow rather than knowledge gaps or lack of training.
“This is exciting in that there doesn’t seem to be an issue with education primarily but rather with the logistical issues that exist in the workflow in a primary care setting,” said Dr. Malhotra.
Participants also noted the need for other improvements. For example, they expressed interest in differentiating migraine from other headache types and having a better understanding of how and when to refer to specialists, said Dr. Malhotra.
These practitioners also want to know more about treatment options beyond first-line medications. “They were interested in understanding more advanced medication treatment options beyond just the typical triptan,” said Dr. Malhotra.
In addition, they want to become more skilled in non-pharmaceutical options such as occipital nerve blocks and in massage, acupuncture, and other complementary forms of migraine management, she said.
The study may be vulnerable to sampling bias as survey participants had just attended an educational symposium on headaches. “They were already, to some degree, interested in improving their knowledge on headache,” said Dr. Malhotra.
Another study limitation was that researchers didn’t conduct a pre-survey analysis to determine changes as a result of the symposia. And as the survey was conducted so close to the symposium, “it’s difficult to draw conclusions on the long-term effects,” she added.
“That being said, First Contact is one of the first national initiatives for primary care education, and thus far, it has been very well received.”
The next step is to continue expanding the program and to create a First Contact for women and First Contact for pediatrics, said Dr. Minen.