Study Suggests Inadequate Provider-Patient Communication Surrounding Medication-Overuse Headache in Migraine Patients

The results of a study presented at the 2023 Annual Scientific Meeting of the American Headache Society (AHS) reported an overall lack of patient awareness and provider communication regarding medication-overuse headache (MOH). In all, 38.6% of patient study participants reported never having heard about MOH. For those patients who had heard of MOH, 38.4% were informed of the condition more than 5 years after migraine diagnosis. Neurologists interviewed in this study noted migraine patients lack basic understanding of MOH and its causes and indicated that conversations surrounding MOH are prompted by providers in response to patient symptoms or behaviors, such as early medication refill requests. Neurologist responders also indicated that while patients who struggle with chronic pain are generally receptive to information about MOH, they are worried about the need to cut back on their medications.

Between May and November 2022, trained research assistants conducted interviews and collected data remotely over secure videoconference software from 200 adult patients with a chart diagnosis of migraine and 13 practicing neurologists. Patients completed a structured, interviewer-administered survey that included sociodemographic characteristics, age at migraine symptom onset and diagnosis, medication overuse headache awareness and knowledge, patient-provider communication, and health literacy. Practicing neurologists completed interviews examining how and when providers speak to patients about MOH, perceptions of patient understanding, and resources providers think would enhance MOH communication. Patient survey data were analyzed using descriptive statistics and bivariate analysis, and qualitative date from interviews with practicing neurologists were analyzed using a modified version of the Rapid Identification of Themes from Audio Recordings (RITA). 

Findings from this study suggest the need for early, intentional, and detailed patient-provider communication and education on MOH as a key to MOH awareness and prevention. Researchers for this study received support from and represent a variety of organizations and companies, including the NIH, Merck, Pfizer, Lundbeck, Gilead, Eli Lilly, and Northwestern University Feinberg School of Medicine.