Effective medical communication missing between physicians and patients with chronic migraine

Many patients with chronic migraine (CM) receive suboptimal medical treatment even when they seek medical care. Reporting at the annual scientific meeting of the American Headache Society, researchers found that the majority of clinical encounters between CM patients and physicians were missing essential components of effective communication. Chronic migraine is a form of migraine in which attacks occur 15 or more days a month.

Richard B. Lipton, MD, director of Montefiore Headache Center and vice chair of neurology, and the Edwin S. Lowe Chair in Neurology, Albert Einstein College of Medicine and Dawn C. Buse, PhD, director, Behavioral Medicine, Montefiore Headache Center and associate professor, Neurology, Einstein, along with research colleagues at Verilogue and Allergan audio recorded 67 scheduled medical visits between 20 neurologists from around the country and their patients with headache disorders, in order to evaluate key elements of medical communication.

An analysis of 35 qualifying visits showed that open-ended questions (e.g., "How do your headaches affect your life?"), which are recommended to initiate a dialogue about chronic migraine, were used in just 4% of encounters. Determining the number of headache days each month is crucial to distinguishing between episodic and chronic migraine. Although migraine frequency was discussed in 70% of encounters, migraine attacks (which often last more than a day) and days with migraine were distinguished just 4% of the time. Headache-related disability, a critical determinant of treatment needs, was discussed in only 30% of encounters. The diagnosis "chronic migraine" was mentioned in just 9% of visits, while treatment plans were discussed in only 37% of visits.

"The study shows we can do much better," Dr. Lipton said. "Effective medical communication is vital to accurate diagnosis, optimizing treatment plans, and facilitating patient adherence. We found that recording actual physician-patient encounters provides a powerful tool for evaluating communication. The next step is to see if improving communication will improve treatment outcomes."