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Migraine Education Improves Quality of Life in a Primary Care Setting

Authors

  • Timothy R. Smith MD, RPh, FACP,

    1. From the Ryan Headache Center/Mercy Health Research – St. John's Mercy Medical Group, St. Louis, MO, USA (T. Smith, R. Nicholson, and J. Banks); Washington University School of Medicine – Internal Medicine, St. Louis, MO, USA (T. Smith); Saint Louis University School of Medicine – Neurology & Psychiatry, St. Louis, MO, USA (R. Nicholson).
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  • Robert A. Nicholson PhD,

    1. From the Ryan Headache Center/Mercy Health Research – St. John's Mercy Medical Group, St. Louis, MO, USA (T. Smith, R. Nicholson, and J. Banks); Washington University School of Medicine – Internal Medicine, St. Louis, MO, USA (T. Smith); Saint Louis University School of Medicine – Neurology & Psychiatry, St. Louis, MO, USA (R. Nicholson).
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  • James W. Banks MD

    1. From the Ryan Headache Center/Mercy Health Research – St. John's Mercy Medical Group, St. Louis, MO, USA (T. Smith, R. Nicholson, and J. Banks); Washington University School of Medicine – Internal Medicine, St. Louis, MO, USA (T. Smith); Saint Louis University School of Medicine – Neurology & Psychiatry, St. Louis, MO, USA (R. Nicholson).
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  • Financial support: Primary Care Network, GlaxoSmithKline Pharmaceuticals, and Abbott Laboratories. The manuscript was prepared while the second author was funded by the National Institutes of Health (NINDS No. K23NS048288).

  • Conflict of Interest: Drs. Smith and Banks have served on speaker's bureaus for GlaxoSmithKline, who provided educational funding for part of this research.

T. Smith, Ryan Headache Center/Mercy Health Research, 12680 Olive Blvd., Suite 200, St. Louis, MO 63104, USA.

Abstract

(Headache 2010;50:600-612)

Objective.— The objective of this study was to evaluate the effectiveness of the Mercy Migraine Management Program (MMMP), an educational program for physicians and patients. The primary outcome was change in headache days from baseline at 3, 6, and 12 months. Secondary outcomes were changes in migraine-related disability and quality of life, worry about headaches, self-efficacy for managing migraines, emergency room (ER) visits for headache, and satisfaction with headache care.

Background.— Despite progress in the understanding of the pathophysiology of migraine and development of effective therapeutic agents, many practitioners and patients continue to lack the knowledge and skills to effectively manage migraine. Educational efforts have been helpful in improving the quality of care and quality of life for migraine sufferers. However, little work has been performed to evaluate these changes over a longer period of time. Also, there is a paucity of published research evaluating the influence of education about migraine management on cognitive and emotional factors (for example, self-efficacy for managing headaches, worry about headaches).

Methods.— In this open-label, prospective study, 284 individuals with migraine (92% female, mean age = 41.6) participated in the MMMP, an educational and skills-based program. Of the 284 who participated in the program, 228 (80%) provided data about their headache frequency, headache-related disability (as measured by the Headache Impact Test-6 (HIT-6), migraine-specific quality of life (MSQ), worry about headaches, self-efficacy for managing headaches, ER visits for headaches, and satisfaction with care at 4 time points over 12 months (baseline, 3 months, 6 months, 12 months).

Results.— Overall, 46% (106) of subjects reported a 50% or greater reduction in headache frequency. Over 12 months, patients reported fewer headaches and improvement on the HIT-6 and MSQ (all P < .001). The improvement in headache impact and quality of life was greater among those who had more worry about their headaches at baseline. There were also significant improvements in “worry about headaches,”“self-efficacy for managing headaches,” and “satisfaction with headache care.”

Conclusion.— The findings demonstrate that patients participating in the MMMP reported improvements in their headache frequency as well as the cognitive and emotional aspects of headache management. This program was especially helpful among those with high amounts of worry about their headaches at the beginning of the program. The findings from this study are impetus for further research that will more clearly evaluate the effects of education and skill development on headache characteristics and the emotional and cognitive factors that influence headache.

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