Simple Screening Tool Accurately Diagnoses Migraine
A 3-item screening tool can accurately and easily diagnose migraine and help to increase triptan prescriptions while decreasing opioid prescriptions, according to a new study.
If patients report headache disability, nausea, and sensitivity to light, “the likelihood of migraine is very, very high,” said K.C. Brennan, MD, director of the Headache Physiology Laboratory at the University of Utah, Salt Lake City. When positive, the screen also recommends appropriate treatment methods.
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The screen was tested at 2 clinics over a 5-week period in 2013. Prior to intervention with the screen, 41% of patients’ records included headache symptom codes, and 18% of patients were prescribed opioids. After the 5 weeks, only 33% of headaches were listed as symptoms, and there was a 37% relative decrease in the number of opioid prescriptions and 36% increase in triptan prescriptions.
“We’re trying to work with the medical directors and get them to implement [screening]. But they still come back saying, ‘Migraine is so hard to diagnose.’ With this system, it’s not hard,” Brennan said.
The tool, which can be administered by a medical assistant, was implemented in response to a review of medical records of more than 50,000 headache patients suggesting that many that should have been diagnosed with a headache disorder, such as chronic migraine, instead only had headache listed as a symptom.
Of the 50,279 headache encounters in the review material, 55.2% had headache listed as a symptom, 41.6% were diagnosed with migraine, and 3.2% received another headache diagnosis.
“The predominant code for these referred patients was 784, which is a symptom code for headache, and provides no diagnostic utility. If you don’t diagnose, there is a much lower likelihood of appropriately treating,” Brennan explained.
More than 36% of patients with a migraine diagnosis had received opiates, which are not normally recommended for migraine, while only 19.1% were prescribed triptans.
“Headache is primary care. It’s more common than asthma and diabetes combined. There’s no excuse for not diagnosing it.”
– Michael Potts
Reference
Brennan KC, Farrell CP, Deough GP, Baggaley S, Pippitt K, Pohl SP, et al. Symptom codes and opioids: disconcerting headache practice patterns in academic primary care. Presented on April 30, 2014 at the Annual Meeting of the American Academy of Neurology, 2014.