Study of severe migraine in general medicine

Objective: To evaluate the criteria of severe migraine in a general population consulting a general practitioner (GP) and to evaluate assessment of migraine severity in the migraine patient as well as treating physicians’ knowledge of their patient’s migraine and its severity.

Methods: We questioned voluntary headache patients who had an appointment with a GP about the severity of their migraine using recognized scores – HIT-6 and MIDAS – as well as with a specific questionnaire created for the study. We compared the criteria for severe migraine with the patient’s description of their symptoms, their HIT-6 score, their MIDAS score, and the GP’s opinion, analyzing collected data using means and standard deviations.

Results: We found that 152 out of 942 headache patients questioned in the general medicine setting met the criteria of « strict migraine », corresponding to 10.3% prevalence. Seventy-one out of 100 patients (71%) with migraine who filled out in the questionnaire completely had what is characterized as « severe migraine ». Forty-one (57%) of the 71 severe migraine patients presented the strict criteria. Additionally, 21 of the 29 (72%) patients with a non-severe diagnosis agreed that their headache was non-severe. When the HIT-6 score was stratified above 65, correspondence between the questionnaire-derived diagnosis and patient perception of severity was observed in 36 of the 58 (62%) with severe migraine. Finally, participating GPs were aware of their patient’s migraine for 60% of patients with migraine. GPs correctly classified the severity of their patient’s migraine for 55 (36%) patients.

Conclusion: GP education and training about migraine remain a public health issue. The diagnosis of severe migraine is necessary for proper patient management. Current criteria for severe migraine are not robust enough; we propose a modification of the criteria.