Headache Diagnosis and Management in Primary Care.

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Headache Diagnosis and Management in Primary Care

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Transcript of Headache Diagnosis and Management in Primary Care.

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HeadacheDiagnosis and Management in Primary Care

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Approaches to Treatment

•Step care

•Staged care

•Stratified care

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MIDASMigraine Disability

•Validated

•Sensitive to change, so good for follow-up

•Link to online version of MIDAS

•http://www.migraine-disability.net/About_Midas/questionnaire5.pdf

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HIT-6

•Validated

•Good for differential diagnosis

•Scoring

Mild impairment 50-55Moderate 56-59Severe ≥60

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Likelihood Ratiosfor diagnosis of migraine

Positive LRNegative LR

00.8 0.4

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Overall Management

Algorithm

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MIPCA Diagnostic Screening Algorithm

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MIPCA Diagnostic Screening Algorithm•Can we make that

algorithm operate in the background and suggest steps in the Plan?

•Hook it to a Headache Condition Summary?

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MIPCA Management

Algorithm

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Close-up 1

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Close-up 1

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Migraine Prophylaxis...

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...Migraine Prophylaxis

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Headache Action Plans

My choice

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Meds

Teaches

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Teaches

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Diary

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Diary

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Patient Handouts

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PowerChart Opportunities

•Integrate Diagnosis decision aids into history-taking

•Migraine Action Plan integrates PowerChart management orders with patient handout

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Migraine Action Plan Potential

•Future patient feedback into chart

•Recent HA pattern

•Treatment response

•Adverse effects

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Headache Dashboard

• Medications

• amitriptyline 10 mg 3 hs

• Maxalt MLT 10

• Aleve 220 4 onset, 2 in 30 min

• levothyroxine 125 mcg/d

DiagnosesMigraineInsomniaHypothyroidismCervical Dysplasia 2002 > cryoDysthymia

Allergies & Intolerancessulfa > as a childpenicillin > hivesImitrex SC > chest pain, anxiety (refuses to take again)

Headache Pathway1.Consult: Hx, Tx history, education, buy-in2.Diagnosis: screen for HA type3.Severity assessment: Frequency, Pain severity, Impact on pt’s life, Non-HA symptoms, Patient factors4.Treatment Plan: Establish goals, Behavioral therapy, Acute therapy, Possible prophylactic therapy, Complementary therapy5.Follow-up: Assess outcomes

Paula Pound DOB: 02/11/1967 MRN: 99 88 77 66 5 ph 573-911-9876 email: [email protected]

Headache DiaryHeadache 1 Headache 2 Headache 3

Date / time

Prodrome / aura

Pain (1-10)

Location / type of pain

Other symptoms

Possible triggers

Meds taken

Did med help?

Med side effects

Other therapies

Did another tx help?

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Headache Dashboard

• Medications

• amitriptyline 10 mg 3 hs

• Maxalt MLT 10

• Aleve 220 4 onset, 2 in 30 min

• levothyroxine 125 mcg/d

DiagnosesMigraineInsomniaHypothyroidismCervical Dysplasia 2002 > cryoDysthymia

Allergies & Intolerancessulfa > as a childpenicillin > hivesImitrex SC > chest pain, anxiety (refuses to take again)

Headache Pathway1.Consult: Hx, Tx history, education, buy-in2.Diagnosis: screen for HA type3.Severity assessment: Frequency, Pain severity, Impact on pt’s life, Non-HA symptoms, Patient factors4.Treatment Plan: Establish goals, Behavioral therapy, Acute therapy, Possible prophylactic therapy, Complementary therapy5.Follow-up: Assess outcomes

Paula Pound DOB: 02/11/1967 MRN: 99 88 77 66 5 ph 573-911-9876 email: [email protected]

Outcome measuresMidas scores# HA / moMissed work daysNon-HA sxTabular form for temporal trendsBrought into PowerForm by nurse at checkin

Drugs tried, failed, whyTopamaxInderal

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Allergies & Intolerancessulfa > as a child Imitrex SC > chest pain, anxiety (refuses to take again)penicillin > hives

Allergies & Intolerancessulfa > as a child

Imitrex SC > chest pain, anxiety (refuses to take again)penicillin > hives

Allergies & Intolerances•sulfa > as a child•Imitrex SC > chest pain, anxiety (refuses to take again)•penicillin > hives

Allergies & Intolerancessulfa > as a childImitrex SC > chest pain, anxiety (refuses to take again) penicillin > hives

Allergies & Intolerancessulfa > as a child

Imitrex SC > chest pain, anxiety (refuses to take again)

penicillin > hives

Allergies & Intolerances•sulfa > as a child•Imitrex SC > chest pain, anxiety (refuses to take again) •penicillin > hives

Algorithm formatting question ...


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Primary Headache

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