Long Wait Time for Headache Specialty Care?

by Lauren Doyle Strauss, DO

Headache is a common reason that patients seek out medical care. It is the fifth most common reason for emergency department (ED) visits and accounts for more than 10 million physician visits annually. Patients suffering with headache can have missed workdays and reduced work
productivity. Annual estimates of lost productivity associated with headache-related disability range anywhere from $1.4 to 17 billion. The number of UCNS certified headache specialists continues to grow and is now over 400, yet wait times to seek specialty care remain long given
the high demand.

Recognizing these concerns, Dr. Ana Marissa Lagman-Bartolome, APN Valerie Lawler, and Dr. Christine Lay designed a recent study looking at the implementation of an educational initiative while a patient was waiting to establish care at their academic headache center, published in
Headache. They launched a program called “Headache Education Active-Waiting Directive” or HEAD which was developed to improve patient knowledge and self-care skills among migraine patients.

The program consists of a workshop session with a 90-minute didactic presentation where patients are educated about headache types, triggers, psychiatric comorbidities, treatment options, lifestyle modifications, medication overuse, and appropriate goal setting. Participants
are advised on use of headache and sleep diaries and given additional educational materials. The session also includes an opportunity to ask questions with an experienced headache APN and share experiences with other headache sufferers. The program also includes a follow up call to enforce the educational initiative 3 months later.

The study was conducted at an academic headache specialty center named the Centre for Headache, located at the University of Toronto’s Women’s College Hospital. At the time of enrollment, more than half of the 177 patients were overusing over the counter medications and a small proportion were on daily preventive medication (15%). Feedback from participants on the usefulness of the HEAD program was favorable with majority (86%, 144/167) reporting that they were either “very satisfied” or “somewhat satisfied.” Participation in the HEAD program
demonstrated a reduction in Migraine Disability Assessment Test scores (MIDAS) (pre-program mean 50.0 ± 64.6 vs post-program mean 43.2 ± 50.8, P = .046), decrease in emergency room utilization (pre-program 33, 22% vs post-program 17, 11%; P = .001), and a reduction in
medication and narcotic use and overuse.

This study highlights the possible role educational programs such as the HEAD program can have in improving migraine related disability even prior to an initial appointment with a headache center.

Article: https://onlinelibrary.wiley.com/doi/10.1111/head.13194/abstract

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