Migraine education improves quality of life in a primary care setting.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of the Mercy Migraine Management Program (MMMP), an educational program for physicians and patients. The primary outcome was change in headache days from baseline at 3, 6, and 12 months. Secondary outcomes were changes in migraine-related disability and quality of life, worry about headaches, self-efficacy for managing migraines, emergency room (ER) visits for headache, and satisfaction with headache care. BACKGROUND: Despite progress in the understanding of the pathophysiology of migraine and development of effective therapeutic agents, many practitioners and patients continue to lack the knowledge and skills to effectively manage migraine. Educational efforts have been helpful in improving the quality of care and quality of life for migraine sufferers. However, little work has been performed to evaluate these changes over a longer period of time. Also, there is a paucity of published research evaluating the influence of education about migraine management on cognitive and emotional factors (for example, self-efficacy for managing headaches, worry about headaches). METHODS: In this open-label, prospective study, 284 individuals with migraine (92% female, mean age = 41.6) participated in the MMMP, an educational and skills-based program. Of the 284 who participated in the program, 228 (80%) provided data about their headache frequency, headache-related disability (as measured by the Headache Impact Test-6 (HIT-6), migraine-specific quality of life (MSQ), worry about headaches, self-efficacy for managing headaches, ER visits for headaches, and satisfaction with care at 4 time points over 12 months (baseline, 3 months, 6 months, 12 months). RESULTS: Overall, 46% (106) of subjects reported a 50% or greater reduction in headache frequency. Over 12 months, patients reported fewer headaches and improvement on the HIT-6 and MSQ (all P < .001). The improvement in headache impact and quality of life was greater among those who had more worry about their headaches at baseline. There were also significant improvements in "worry about headaches,""self-efficacy for managing headaches," and "satisfaction with headache care." CONCLUSION: The findings demonstrate that patients participating in the MMMP reported improvements in their headache frequency as well as the cognitive and emotional aspects of headache management. This program was especially helpful among those with high amounts of worry about their headaches at the beginning of the program. The findings from this study are impetus for further research that will more clearly evaluate the effects of education and skill development on headache characteristics and the emotional and cognitive factors that influence headache.

The importance of incorporating faith and spirituality issues in the care of patients with chronic daily headache.

Patients with chronic daily headache are difficult and often frustrating to treat. They are in many ways similar to chronic pain patients and patients with other chronic serious illnesses that have come to alter many aspects of their life, affecting their physical and emotional well-being, their ability to work, and their family and social relationships. The best treatment strategies for patients with chronic disease combine pharmacologic and behavioral strategies with the behavioral strategies incorporating body, mind, spirit, and social interactions. Numerous studies have demonstrated a positive association between being religious or spiritual and improved health, both in response to acute events and in chronic disease. Because religion is so positively associated with improved outcomes, it is important for physicians to recognize this aspect of a patient's life and try to encourage positive use of the patient's belief system as an adjunct in treatment.