The Impact of Intensive Patient Education on Clinical Outcome in a Clinic-Based Migraine Population

Authors

  • John Farr Rothrock MD,

  • Victoria A. Parada MD,

  • Cheryl Sims,

  • Kristin Key,

  • Naomi S. Walters,

  • Richard M. Zweifler MD

Errata

This article is corrected by:

  1. Errata: ERRATA Volume 46, Issue 7, 1227, Article first published online: 6 July 2006

  • From the Department of Neurology, University of South Alabama, Mobile, AL.

Address all correspondence to Dr. John F. Rothrock, Department of Neurology, University of South Alabama, 3401 Medical Park Drive, Building 3, Suite 205, Mobile, AL 36693.

Abstract

Objective.—To determine whether the addition of patient education to routine medical management improves the clinical status of migraine patients and reduces their utilization of healthcare resources.

Background.—Optimal migraine management typically requires effective patient education. Such education often is difficult to accomplish in the busy clinic setting.

Methods.—One hundred consecutive patients with migraine presenting to an university-based headache clinic were randomized to receive or not receive a standardized course of didactic instruction regarding migraine biogenesis and management. The course consisted of 3 classes taught by lay migraineurs who themselves previously had undergone intensive training. All patients were evaluated initially and at 1, 3, and 6 months by a neurologist blinded as to the results of randomization. Clinical variables examined included headache frequency/severity, migraine disability assessment (MIDAS) scores, patient compliance, presence versus absence of analgesic use/overuse, and headache-related unscheduled visits or phone calls. Comparisons were made between baseline findings and findings at the 6-month follow-up visit, with the change in mean MIDAS score serving as the primary outcome variable.

Results.—At 6 months the group randomized to receive intensive education exhibited a significantly greater reduction in mean MIDAS score than the group randomized to routine medical management only (24 vs. 14 points; P < .05). Those patients also experienced a reduction in mean headache days per month and a greater reduction in functionally incapacitating headache days per month, exhibited less analgesic overuse and need for abortive therapy, were more compliant with prophylactic therapy prescribed, and made fewer headache-related calls to the clinic or unscheduled visits.

Conclusion.—Intensive education of migraine patients by trained lay instructors may convey significant benefit to those patients and reduce their utilization of healthcare resources.

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