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  • Writer's pictureFred Cohen

Headache Medicine in Primary Care

Approximately 16% of the US population is impacted by migraines, making them one of the most common neurological disorders.1 Among women aged 15 to 49 years, migraines rank as the leading cause of years lived with disability and the second-highest overall.2 Headaches consistently rank among the top five reasons for emergency department visits, imposing a significant burden on healthcare facilities.3 The estimated annual direct healthcare cost for migraine patients in the US is approximately $22,364 per person, with an even more substantial indirect total cost exceeding 19 billion dollars.4

Headaches are a frequent complaint faced by medical providers, with primary care providers (PCPs) being the most common to address this condition. It has been reported that over 70% of individuals suffering from migraines seek aid from their PCP, while 28.1% and 15.6% will seek a neurologist and headache specialist, respectively5. Shockingly, only 6.3% of those with episodic migraines receive minimally appropriate care, including accurate diagnosis, proper consultation, and evidence-based therapy.6 Moreover, it is estimated that 40.4% of migraine sufferers could benefit from prevention therapy, but only 16.8% are currently prescribed one.

Despite significant advancements in migraine treatments, such as onabotulinum injections and calcitonin gene-related peptide antibodies, access to care remains an on-going issue. As one of the few dual boarded internal medicine / headache medicine providers in the country I firmly advocate for increased emphasis on headache medicine within the primary care sector. Organizations like the American Headache Society and the National Headache Foundation have created programs to increase awareness among PCPs, but further progress is required. As an assistant professor of medicine (and neurology) at Mount Sinai, I have started educating internal medicine residents on headache diagnosis and treatments. While we are making strides in migraine treatments, such as the recent release of the 3rd generation gepant, zavegepant (Zavzpret ™), access remains critically limited, especially given the healthcare provider shortage our nation is facing. To enhance the care and treatment of headaches and migraines, I strongly advocate for allocating more resources to headache medicine education for PCPs.

1. Burch R, Rizzoli P, Loder E. The prevalence and impact of migraine and severe headache in the United States: Updated age, sex, and socioeconomic-specific estimates from government health surveys. Headache. 2021;61:60-68.

2. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17:954-976.

3. Burch R, Rizzoli P, Loder E. The Prevalence and Impact of Migraine and Severe Headache in the United States: Figures and Trends From Government Health Studies. Headache. 2018;58:496-505.

4. Yucel A, Thach A, Kumar S, Loden C, Bensink M, Goldfarb N. Estimating the economic burden of migraine on US employers. Am J Manag Care. 2020;26:e403-e408.

5. Lipton RB, Nicholson RA, Reed ML, et al. Diagnosis, consultation, treatment, and impact of migraine in the US: Results of the OVERCOME (US) study. Headache. 2022;62:122-140.

6. Lipton RB, Munjal S, Alam A, et al. Migraine in America Symptoms and Treatment (MAST) Study: Baseline Study Methods, Treatment Patterns, and Gender Differences. Headache. 2018;58:1408-1426.

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