HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Data Supplement Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lipton, R. B. Articles by Silberstein, S. D. Search for Related Content PubMed PubMed Citation Articles by Lipton, R. B. Articles by Silberstein, S. D. Related Collections All Headache All Clinical Neurology

Migraine practice patterns among neurologists

From the Departments of Neurology (Drs. Lipton and Bigal) and Epidemiology and Population Health (Dr. Lipton), Albert Einstein College of Medicine, Bronx, NY, New England Center for Headache (Dr. Bigal), Stamford, CT, American Academy of Neurology (S.R. Rush), St. Paul, MN, Deskin Communications Group (Dr. Yenkosky), Minneapolis, MN, Advance PCS (Dr. Liberman), Hunt-Valley, MD, Mayo Clinical (Dr. Bartleson), Rochester, MN, and Department of Neurology (Dr. Silberstein), Thomas Jefferson University School of Medicine, and Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, PA.

Address correspondence and reprint requests to Dr. R.B. Lipton, Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY, 10461; e-mail: Rlipton{at}aecom.yu.edu

Objective: To assess the attitudes, knowledge, and practice patterns of US neurologists regarding migraine management relative to the US Headache Consortium Guidelines (the Guidelines).

Methods: Two samples of 600 neurologists each were selected from the American Academy of Neurology membership database. The first group received a Migraine Attitudes, Knowledge, and Practice Patterns (MKAPP) Survey. The second group received a Clinical Vignette (CV) Survey, presenting two patient histories and correspondent questions.

Results: The MKAPP Survey showed that most neurologists felt that migraine was primarily a disease of the brain with a well-established neurobiological basis (69%) and an important part of their practice (60%). Most (53%) indicated that they routinely used neuroimaging in evaluating severe headache, an approach not recommended by the Guidelines. Most favored acute treatment limits, but 36% did not agree with the Guidelines that acute treatment should be limited to 2 or 3 days/week. In the CV Survey, for vignette 1, most (91%) correctly diagnosed migraine, 31% requested neuroimaging in the absence of indications, 64% appropriately recommended a triptan, and 45% recommended a preventive medication in the absence of indications. For vignette 2, 78% diagnosed migraine, 71% appropriately ordered neuroimaging, 80% appropriately recommended a preventive medication, and 38% prescribed a triptan in face of clear contraindication.

Conclusions: Educational initiatives aiming to increase the awareness of the Guidelines among neurologists should highlight the full range of migraine symptoms that support the diagnosis, appropriate use of neuroimaging, indications for preventive treatments, issues of triptan cardiovascular safety, and preventing rebound headaches.

Received November 13, 2002. Accepted in final form February 17, 2004.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the June 8 issue to find the title link for this article.

This article has been cited by other articles:

				W. D. Graf, H. R. Kayyali, J. J. Alexander, S. D. Simon, and M. C. Morriss Neuroimaging-Use Trends in Nonacute Pediatric Headache Before and After Clinical Practice Parameters Pediatrics, November 1, 2008; 122(5): e1001 - e1005. [Abstract] [Full Text] [PDF]