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Shared Decision-making for Migraine
Using Shared Decision-making to Relieve the Burden of Migraine

Released: December 20, 2023

Nada Hindiyeh
Nada Hindiyeh, MD, FAHS
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Key Takeaways
  • Migraine remains a significant burden to patients, their families, employers, healthcare institutions, and the economy, but it continues to be underdiagnosed and undertreated.
  • Following a diagnosis of migraine, it is essential for healthcare professionals to discuss both acute and preventive treatment strategies with patients to ensure a proactive approach to therapy. 

Migraine is a complex, chronic, heritable neurologic disorder consisting of recurrent, debilitating attacks of headache that generally are associated with nausea or light and sound sensitivity. Migraine is one of the most common neurologic disorders worldwide, affecting 1.1 billion people. In the United States alone, migraine affects more than 39 million people. That amounts to 1 in every 6 Americans, and for women that number is even higher: 1 in 5 women, or 20% of women in the United States, experience migraine attacks. Moreover, based on the 2019 Global Burden of Disease study, migraine is the second-leading cause of years lived with disability —and for women 15-49 years of age, it is the leading cause of years lived with disability.

The Unseen Burden of Migraine
Migraine remains a significant burden to patients, their families, employers, healthcare institutions, and the economy. Approximately one half of people with migraine report being unable to participate in family activities, and 1 in 3 worry about long-term security for themselves and their families. Nearly 70% of people with high-frequency, episodic migraine and 80% of people with chronic migraine reported moderate to severe migraine disability . In addition, 91% of patients with migraine cannot function normally during an attack, and 64%  report moderate to severe burden between attacks. In the United States, headache accounts for 3% of emergency department (ED) visits per year and repeatedly has been the fourth or fifth most common reason for an ED visit.  In women of child-bearing age, it is the third most common reason for an ED visit.  Moreover, direct and indirect healthcare utilization costs (eg, absenteeism, disability) for people living with migraine are nearly $9,000  higher than people without migraine annually. 

Despite these staggering statistics, migraine remains underdiagnosed and undertreated. More than 40% of people with migraine are eligible for preventive treatment, but only 16% are currently using a preventive treatment option . Every year, 3% of people experience escalation from episodic migraine to chronic migraine , which is when patients experience 15 or more headache days per month. Migraine is a condition that frequently becomes increasingly more debilitating, but this largely can be avoided with appropriate diagnosis and proactive interventions to prevent and acutely treat migraine. 

Simplifying Diagnosis of Migraine
Migraine may be a complex neurologic disorder, but diagnosis can be simple. The ID Migraine, a simplified diagnostic tool, can help any healthcare professional quickly and easily diagnose migraine. If patients have experienced 2 of 3 symptoms —namely light sensitivity, nausea, or decreased ability to function with headache—in the past 3 months, the diagnosis is likely migraine. It is important to recognize some misconceptions that hinder accurate diagnosis. For instance, not all people with migraine have an aura with their attacks—in fact, only approximately 25%  ever report aura. Furthermore, migraine attacks do not have to be unilateral, and many people experience bilateral and all-over head pain. 

Shared Decision-making in Migraine Treatment
Once a diagnosis has been made, it is essential to discuss both acute and preventive treatment strategies with patients. Treatment responsibility should be shared and agreed upon between healthcare professionals and patients, and all patients should have an acute treatment strategy, whether that is over-the-counter treatment, noninvasive devices, or prescription medication.  When headache attacks become more debilitating or bothersome, a discussion about preventive treatments should ensue. There are many prescription preventive options for those who are interested, so it is important to discuss comorbidities, medication preferences, and insurance limitations with the patient to choose an option that best suits their individual needs. All patients should be educated on the importance of lifestyle modifications, and natural supplements should be discussed and recommended if the patient is not interested in prescription options. It is important to remember that treatment of migraine is not a one-time encounter and can require treatment adjustments and additions. As healthcare professionals, it is our duty to support our patients along this journey to work with them toward more headache-free days.

Your Thoughts?
How do you incorporate shared decision-making into your treatment of migraine? Leave a comment below to join the discussion.