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In-office Discussions of Migraine: Results from the American Migraine Communication Study

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Abstract

Background

Research indicates that successful migraine assessment and treatment depends on information obtained during patient and healthcare professional (HCP) discussions. However, no studies outline how migraine is actually discussed during clinical encounters.

Objective

Record naturally occurring HCP–migraineur interactions, analyzing frequency and impairment assessment, and preventive treatment discussions.

Design

HCPs seeing high volumes of migraineurs were recruited for a communication study. Patients likely to discuss migraine were recruited immediately before their normally scheduled appointment and, once consented, were audio- and video-recorded without a researcher present. Separate post-visit interviews were conducted with patients and HCPs. All interactions were transcribed.

Participants

Sixty patients (83% female; mean age 41.7) were analyzed. Patients were diagnosed with migraine 14 years and experienced 5 per month, on average.

Approach

Transcripts were analyzed using sociolinguistic techniques such as number and type of questions asked and post-visit alignment on migraine frequency and impairment. American Migraine Prevalence and Prevention Study guidelines were utilized.

Results

Ninety-one percent of HCP-initiated, migraine-specific questions were closed-ended/short answer; assessments focused on frequency and did not focus on attention on impairment. Open-ended questions in patient post-visit interviews yielded robust impairment-related information. Post-visit, 55% of HCP–patient pairs were misaligned regarding frequency; 51% on impairment. Of the 20 (33%) patients who were preventive medication candidates, 80% did not receive it and 50% of their visits lacked discussion of prevention.

Conclusions

Sociolinguistic analysis revealed that HCPs often used narrowly focused, closed-ended questions and were often unaware of how migraine affected patients’ lives as a result. It is recommended that HCPs assess impairment using open-ended questions in combination with the ask-tell-ask technique.

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Acknowledgements

The authors wish to thank Ortho-McNeil Neurologics and Corey Eagan of MBS/Vox.

Conflict of interest summary

Dr. Lipton has received grants from Allergan, Advanced Bionics Corporation, GlaxoSmithKline, Merck & Co., Inc., Neuralieve, Ortho-McNeil, Pfizer, Proethics Ltd., and St. Jude Children’s Research Hospital. He has consulted for Allergan, Ortho-McNeil, and Pfizer.

Dr. Hahn has received honoraria from GlaxoSmithKline, Eli Lilly and Company, Ortho-McNeil, and Pfizer. He has consulted with GlaxoSmithKline, Eli Lilly and Company, Ortho-McNeil, and Pfizer.

Dr. Cady is the owner of Banyan Group, Inc., a medical clinic, clinical research facility, and meeting planning division that conducts medical education. Banyan Group has received grants from Abbott Laboratories, Advanced Bionics Corporation, Alizyme, Allergan, Alexza Pharmaceuticals, Aradgim Corporation, CAPNIA, Incorporated, Cipher Pharmaceuticals, Inc., Eisai, Inc., Endo Pharmaceuticals, GelStat Corp., GlaxoSmithKline, Jazz Pharmaceuticals, Johnson & Johnson, MAP Pharmaceuticals, Matrixx Initiatives, Inc., Merck & Co., Neuralieve, Novartis, Ortho-McNeil, Pfizer, Pozen Pharmaceutical Development Company, SCHWARZ Pharma AG, Torrey Pines, and Vernalis. He has received honoraria from ABT Associates, Allergan, Aradgim Corp., Atrix, Capnia, Endo, GlaxoSmithKline, Jazz Pharmaceuticals, Johnson & Johnson, MedPointe Pharmaceuticals, Merck & Co., Inc., and Winston Laboratories, Inc. He has consulted for ABT Associates, Allergan, Aradgim Corp., Atrix, CAPNIA Incorporated, Endo Pharmaceuticals, GlaxoSmithKline, Jazz Pharmaceuticals, Johnson & Johnson, MedPointe Pharmaceuticals, Merck & Co., Inc., and Winston Laboratories, Inc.

Dr. Brandes has received clinical or educational support from Advanced Bionics Corporation, Allergan, AstraZeneca, Bristol-Myers Squibb, Elan Pharmaceuticals, Endo Pharmaceuticals, GlaxoSmithKline, Johnson & Johnson, Merck & Co., Inc., Novartis, Ortho-McNeil, Pfizer, Pozen Pharmaceutical Development Company, Sanofi-Aventis, UCB, Vernalis, and Winston Laboratories, Inc. She is on the Speakers’ Bureau/Advisory Board for Allergan, AstraZeneca, Endo Pharmaceuticals, GlaxoSmithKline, Merck, Ortho-McNeil, and Pfizer.

Ms. Simons has no conflicts to declare.

Dr. Bain has no conflicts to declare.

Ms. Nelson has no conflicts to declare.

Author information

Authors and Affiliations

  1. Department of Neurology, Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Richard B. Lipton MD

  2. Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA

    Steven R. Hahn MD

  3. Banyan Group, Inc., Springfield, MO, USA

    Roger K. Cady MD

  4. Vanderbilt University School of Medicine, Nashville, TN, USA

    Jan Lewis Brandes MD, MS

  5. National Headache Foundation, Chicago, IL, USA

    Suzanne E. Simons

  6. Dean Health System, Madison, WI, USA

    Philip A. Bain MD

  7. MBS/Vox, Parsippany, NJ, USA

    Meaghan R. Nelson MS

Authors
  1. Richard B. Lipton MD
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  2. Steven R. Hahn MD
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  3. Roger K. Cady MD
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  4. Jan Lewis Brandes MD, MS
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  5. Suzanne E. Simons
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  6. Philip A. Bain MD
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  7. Meaghan R. Nelson MS
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Corresponding author

Correspondence to Richard B. Lipton MD.

Additional information

Study design and subsequent publication were a joint effort by MBS/Vox, academic co-authors, and Ortho-McNeil Neurologics. All data collection and analysis was conducted by MBS/Vox. Funding was provided by Ortho-McNeil Neurologics.

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Lipton, R.B., Hahn, S.R., Cady, R.K. et al. In-office Discussions of Migraine: Results from the American Migraine Communication Study. J GEN INTERN MED 23, 1145–1151 (2008). https://doi.org/10.1007/s11606-008-0591-3

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  • DOI: https://doi.org/10.1007/s11606-008-0591-3

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