Headache can be safely diagnosed in the primary care setting and advanced medications are available.
There is a shortage of neurologists nationwide, and main care physicians can help fill the gap in migraine care, a headache expert says.
Migraine is one associated with the most common disabling medical conditions, according to the American Migraine Foundation . In the United States, 1 in 4 households has a family member who suffers from migraine, and migraine affects 1 out of 7 people globally, the foundation says.
Recent advancements inside migraine treatment and research make treating migraine within the primary care setting easier, says Loretta Mueller, OD, a head ache specialist plus family physician at Cooper University Health Care, which is based in Camden, New Jersey. “There has been a boom of new therapies in recent years and a lot more study going on. It is a good time to become treating headache and researching headache. The newer medications that are out generally are usually tolerated better than the particular older medicines, and many of them work much quicker than the older medications. ”
Primary care physicians have several medication options for migraine that have become available over the past four years, she says. “The newer ones that possess come out since 2018 include injected monoclonal antibodies that will target the particular calcitonin gene-related peptide, which is migraine specific. We also have got new oral medications called gepants that also target the calcitonin gene-related peptide. Two of the dental treatments are for as-needed use once a headache starts—rimegepant, which will be Nurtec ODT, and ubrogepant, which is Ubrelvy. We also have a new medication that is only with regard to headache prevention—atogepant, that is Qulipta. Nurtec ODT can also be used regarding prevention, when taken every other day. ”
Detecting migraine within the major care setting
Diagnosing migraine is appropriate for the principal care setting, Mueller states. “It is not a procedural field, so each primary treatment physician who has an interest in head ache should be able to treat migraine. It is just a matter of having the time to sit down and provide the care as well as having the education about what to look for. The reality is that most of what you are going to see in a primary treatment practice is usually migraine. So , if primary care physicians were taught to start with the diagnosis associated with migraine plus work backwards from there, we would have a lot more patients who could be easily treated intended for migraine. inch
To diagnose migraine, main care doctors should review the patient’s medical history and schedule the visit to focus on the person’s headaches, the girl says.
“The medical history is key as well because dedicating an office visit specifically to get headaches rather than just having a by-the-way complaint when a patient is in the particular office pertaining to high blood pressure or another condition. The primary care doctor should focus only on headache during a visit. I see nothing but headache patients on a hospital’s neurology floor, and it takes me a good hour with a new patient, yet we do have migraine identifiers such since ID Migraine , which usually is only three questions: Have you not been able to function at least one day out of the past three months because of your headaches? Do a person ever get nauseous with your headaches? Do you ever get light sensitivity together with your headache? If two from those three are positive, there is definitely about a 93% chance that will the condition is headache. If all three are usually positive, there is a 98% chance that the particular condition can be migraine. inches
Primary care physicians can use tools to rule out more serious causes of headaches such as SNOOP , Mueller says.
- ‘S’ is for systemic symptoms such as cancer.
- ‘N’ is perfect for neurologic abnormalities.
- The particular first ‘O’ is onset of rapid escalation of pain within seconds or the so-called thunderclap headache that can be a marker for aneurysm or brain bleed.
- The second ‘O’ is for onset of recent headache over the age of 50.
- ‘P’ is meant for prior headache history, where a change in head ache history such as increased severity or frequency could end up being signs of the serious condition.
Treating migraine in the primary treatment setting
The treatment of migraine requires a holistic approach to care, Mueller says. “It comes down to a clinical judgment call. There is no single algorithm as is certainly the case designed for other conditions such as a diagnosis of Lyme disease calling for the specific antibiotic. There is some art in the treatment of migraine because many associated with these patients have other comorbidities like depression plus anxiety. You look at the whole picture. ”
Migraine treatment can be complicated, the lady says. “There are many therapy options. For example , how numerous medications do you go through or how many classes of medications do you go through with the patient in shared decision-making. A lot associated with migraine care requires shared decision-making. Some patients definitely have a preference while to exactly what they are looking for or side effects that they perform not want. Some migraine medications have weight gain associated with them. ”
Christopher Cheney is the senior clinical care editor in HealthLeaders.