Getting an accurate diagnosis is essential for proper treatment of Migraine, yet not all doctors have the same knowledge about Migraine. We’re more likely to receive the correct diagnosis and the most appropriate treatment when choosing the right doctor. A growing body of evidence tells us that doctor choice matters. As consumers of health care services, we have a responsibility to choose wisely.
Getting the right diagnosis
A 2016 study of 188 Migraine patients found that fewer than half of those with chronic Migraine were accurately diagnosed. Recommended treatment of chronic Migraine is different than treatment for episodic Migraine. This high misdiagnosis rate tells us that millions of people living with Migraine are not receiving the correct diagnosis, let alone the optimal treatment.
- Episodic Migraine is defined as 14 or fewer headache days per month. Even episodic Migraine often requires treatment. If we experience three or four Migraine attacks per month or our attacks are especially severe, our doctor should discuss preventive treatment options with us. Early intervention is essential to prevent the development of chronic Migraine. Topiramate (Topamax) is one of four FDA approved preventive treatments for episodic migraine. It is the most frequently prescribed preventive. However, there are over 100 different medications that are used off-label to prevent migraine. Common treatments include, but are not limited to, anti-seizure medications, anti-depressants, calcium channel blockers, and beta blockers.
- Chronic Migraine defined as 15 or more migraine or headache days per month. At least eight of the 15 must be Migraine days. Botox (onabotulinumtoxina) is the only FDA-approved treatment for chronic Migraine. Despite this, many insurance companies require patients to fail up to three other classes of medications before approving Botox.
Getting the right treatment
The 2016 U.S. National Health and Wellness Survey identified 197 patients with Migraine. Researchers collected data regarding type of physician and prescribed preventive treatments. Patients were classified as either at-risk episodic (four to 14 Migraine attacks per month) or chronic (15 or more Migraine attacks per month).
- Of the 121 patients with episodic Migraine, only five were treated with topiramate (Topamax). Six were treated with Botox.
- Only nine of the 76 patients with chronic Migraine were treated with Botox. Topiramate (Topamax) was prescribed for 13 patients with chronic Migraine.
- Patients treated by a neurologist were more likely to be prescribed either Botox or topiramate (Topamax).
- The survey did not include any other treatment options, nor did it specify if topiramate (Topamax) or Botox had been previously used unsuccessfully.
Impact on patients:
Both studies demonstrate the need for improved physician education on both the diagnosis and treatment of Migraine. Given the significant shortage of Migraine specialists, training physicians in all specialties is essential. Most importantly, primary care physicians need Migraine treatment guidelines.
What you can do
- Ask your doctor about his/her training in the diagnosis and treatment of Migraine.
- Don’t hesitate to request a second opinion.
- Educate yourself on the diagnosis and treatment of Migraine.
- Consider a migraine specialist, even if you must travel.
- Dodick D, Loder E, Adams, A, et al. “Assessing Barriers to Chronic Migraine Consultation, Diagnosis, and Treatment: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study.” Headache. May 2016. Volume 56, Issue 5, pages 821–834.
- Lee, L, Bell J, Fitzgerald T, et al. (2016). Preventive Prescription Patterns in Migraine Patients by Healthcare Provider, American Headache Society Program Abstracts, June 2017, 166.
- Pavolovic J, Yu J, Silberstein S, et al. (2016). Patterns of Chronic Migraine Diagnosis Among Patients with Migraine in an Accountable Care Organization, American Headache Society Program Abstracts, June 2017, 172-173.
© Copyright 2018 Tammy Rome. All rights reserved.
Medical Review by: David Watson, MD