Recognition and Management of Migraine in Primary Care: Influence of Functional Impact Measured by the Headache Impact Test (HIT)

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Abstract
The objective of the present study was to investigate the influence of headache-related disability on the recognition and management of migraine by French general practitioners (GPs). Forty-nine teaching GPs at the Faculty of Medicine in the Nice-Sophia-Antipolis University were involved in this study. On one day, each patient who presented during the surgery hours of these GPs was invited to complete a questionnaire aimed at identifying if he/she was a headache sufferer and, if so, whether the headache corresponded to migraine and had an impact on his/her functional ability. Functional disability was measured by the short-form of the Headache Impact Test (HIT-6). Being blind to the patients' responses, the GPs completed a questionnaire for each patient aimed at identifying if he/she considered the patient to suffer from migraine and, if so, whether he/she managed the patient for migraine. A total of 696 patients were included in this study and 289 (41.52%) of them had episodic headache. According to the new International Headache Society (IHS) criteria, 113 (16.24%) patients suffered from headache without migrainous features and 176 (25.29%) patients were migraine sufferers (migraine according to IHS categories 1.1 and 1.2.1: 11.21%, and probable migraine according to IHS categories 1.6.1 and 1.6.2: 14.08%). The mean HIT score of these migraine sufferers was 59.1 + 8.8 and 50% of them presented with a very severe impact score (HIT score > 60). Among the 176 migraine sufferers, 105 (59.7%) were not recognized as having migraine, 21 (11.9%) were recognized as having migraine but without migraine management and 50 (28.4%) were recognized as having migraine with migraine management. Recognition of migraine by GPs was statistically associated with the HIT score (OR = 1.105, 95% CI: 1.056-1.157, P < 0.001) and with the 1.1 and 1.2.1 IHS diagnostic categories (OR = 2.942, 95% CI: 1.286-5.025, P = 0.0107) whereas management of patients recognized as having migraine was only associated with the patient's age (OR = 1.051, 95% CI: 1.000-1.104, P = 0.0486). These results indicate that the continuing medical education of GPs should focus on the diagnosis of migraine and its impact on the lifestyle of the patient.