Migraine Management Toolkit
Provided by AAFP partner
Why Focus on Migraine Management?
Migraine is a prevalent and debilitating neurological disorder, affecting over 1 billion people globally.1-3 In the US alone, approximately 40 million individuals suffer from migraine, making it the second most common neurological disease in the country.3,4 Interestingly, migraine is about three times more common in females than in males, highlighting the need for tailored and informed care approaches.5,6
Migraine can significantly impair patients' quality of life and may disrupt sleep, daily activities, relationships and overall enjoyment.3,7-9 The economic burden is substantial, with direct and indirect costs, including productivity losses, ranging between $18 million and $155 million annually in the US.10 Chronic migraine costs per person per year exceed $8,200, while episodic migraine costs are over $2,600.11 This economic impact underscores the importance of effective migraine management.
Despite advancements in understanding migraine pathophysiology and treatment, the condition remains widely underdiagnosed and often misdiagnosed.5 The average time between onset and diagnosis is estimated to be approximately 3.3 years.5 Patients with chronic migraine are 57% less likely to receive an accurate diagnosis compared to those with episodic migraine.12
The Mnemonic RATE: A Framework for Migraine Management
The Migraine Management Toolkit introduces the mnemonic RATE (Recognize, Assess, Treat, Evaluate), which serves as a potential approach for healthcare professionals to help remind them about the diagnosis and management of migraine.
Recognize
When to suspect migraine in patients 13
- Recurrent headache of moderate to severe intensity
- Visual aura, nausea and/or vomiting
- Family history of migraine
Assess
Using a combination of 13
- Detailed history taking
- Physical examination
- Screening for secondary headache and consideration of differential diagnoses
- Validated diagnostic and screening tools
Treat
Acute treatment 13,14
For patients with a confirmed diagnosis of migraine
Preventive treatment 13,14
- For patients whose attacks significantly interfere with daily routines despite acute treatment
- For those who have frequent attacks, intolerance or contraindication(s) to acute treatments, or failure or overuse of acute treatments
Evaluate
Family physicians should play a role in the long-term management of migraine.13
- It is important to evaluate the impact of the treatment plan on migraine.
- Treatment plans should be revised and optimized for each patient, as appropriate.
Your Role in Migraine Management
Family physicians play an important role in today's healthcare landscape and are critical in the diagnosis, treatment and management of a wide array of conditions, including migraine. You are invited to explore the Migraine Management Toolkit and view a recorded webinar on diagnosis and treatment considerations. The RATE Migraine website also offers evidence-based resources for healthcare professionals that may help you diagnose, treat and evaluate your patients with migraine.
With the right tools and knowledge, you have the potential to make a significant difference in your patients' health and quality of life.
REFERENCES
- GBD 2016 Headache Collaborators. Lancet Neurol. 2018;17:954-976.
- Stovner LJ, et al. J Headache Pain. 2022;23:34.
- GBD 2017 US Neurological Disorders Collaborators, et al. JAMA Neurol. 2021;78:165-176.
- Law HZ, et al. Plast Reconstr Surg Glob Open. 2020;8:e2790.
- Lipton RB, et al. Headache. 2022;62:122-140.
- Lipton RB, et al. Headache. 2018;58:1408-1426.
- Gibbs SN, et al. Headache. 2020;60:1351-1364.
- Martelletti P, et al. J Headache Pain. 2018;19:115.
- Buse DC, et al. Headache. 2019;59:1286-1299.
- Yucel A, et al. Am J Manag Care. 2020;26:e403-e408.
- Messali A, et al. Headache. 2016;56:306-322.
- Buse DC, et al. Headache. 2021;61:628-641.
- Eigenbrodt AK, et al. Nat Rev Neurol. 2021;17(8):501-514.
- Ailani J, et al. Headache. 2021;61(7):1021-1039.
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