Better Migraine Knowledge Needed Among Primary Care Providers

Man with migraine
Man with migraine
Uncertainty about when to order imaging studies, existing guidelines on migraine preventive treatments common.

WASHINGTON — Many primary care providers are uncertain of how to best manage patients with migraine, despite being aware of the prevalence of the condition in the patients they treat.

Previous studies have shown that migraine is often under-recognized, misdiagnosed and inadequately treated in primary care settings.

“There are many opportunities for primary care providers and neurologists to work together to improve patient care especially for migraine,” Mia Minen, MD, MPH, director of headache services at New York University’s Langone Medical Center, said during an interview at the American Academy of Neurology (AAN) 2015 meeting.

To investigate the issue, she and colleagues conducted focus groups with primary care providers and distributed a comprehensive survey to 120 primary care physicians at Brigham and Women’s Hospital in Boston.

They found that only 28% of the 83 physicians who completed the survey were familiar with the AAN guidelines on preventive treatment, and 40% were familiar with the Institute of Medicine’s Choosing Wisely Campaign recommendations on migraine treatment.

“There was some question about when they should be ordering imaging studies for migraneurs,” noted Minen. When asked about the indications for when MRI is warranted:

  • 47% said they would order an MRI for a new type of headache
  • 31% said they would order one for a worsening headache
  • 35% said they would order one for a headache that’s not responsive to treatment

Although 79% had heard of medication overuse headache, only 34% were aware narcotics, and about half (54%) were aware that butalbital-containing products can contribute to migraine diagnosis.

“There are many novel ways that we can improve the integration of headache medicine and primary care,” emphasized Minen. Among survey respondents, 56% said they would welcome more opportunity with direct contact with physicians with headache knowledge, 46% favored lunchtime staff meetings, and 39% responded having a neurologist in the clinic to see patients and answer staff questions would be helpful.

Minen called for better basic science courses on headache for students training in primary care and internal medicine programs; integration of neurology and headache clinic rotations into residency programs; and more email and telemedicine consultation services.


  1. Minen M et al. #S23.006. “Migraine Diagnosis and Treatment: A Knowledge and Needs Assessment Among Primary Care Providers.” Presented at: AAN 2015. April 18-25, 2015; Washington, D.C. 

Video Editor: Brianne Aiken; Videographer/Producer: Nicole Blazek