A growing number of patients in the United States are struggling with migraine. Migraine patients deal with a variety of challenges throughout the patient care pathway that can cause insufficient care. This can lead to adverse impacts on patients, employers, and health systems.

Pfizer and Optum¹ worked together to collect provider insights and identify gaps in care within the current workflows for migraine screening and management in the primary care setting. Pfizer partnered with Optum across three regions — the West, Midwest, and Northeast — to understand providers’ approaches to migraine care and identify opportunities to optimize the migraine patient journey. Although Optum providers were interviewed, these insights are applicable to all health systems looking to improve their migraine care strategy. As part of this process, Pfizer and Optum:

1. Interviewed clinicians and other subject matter experts in primary care and neurology at Optum sites to identify current migraine patient management workflows and care gaps.

2. Facilitated a joint design workshop with migraine subject matter experts to address the care gaps identified in interviews. As a result of the design workshop, Pfizer and Optum developed several migraine resources.

3. Used these insights to develop a toolkit to help health systems and providers more efficiently diagnose and treat patients with migraine, as well as migraine education materials to help patients better understand migraine symptoms and treatments.

The following sections outline what Pfizer and Optum found to be the most critical challenges to effective migraine care — and potential solutions to those challenges.

Primary care providers often rely on their personal experience managing migraine, leading to missed care improvement opportunities, as well as inconsistent standards across providers with different experiences and treatment backgrounds. This doesn’t mean health systems need to create a new migraine care protocol themselves. Instead, existing, clinically-validated migraine care protocols are available for health systems to implement.

While standardizing protocols may seem daunting, health systems can apply their experiences standardizing care for other chronic diseases to migraine management. Consider which chronic disease management structures and strategies are already in place across different disease states that may scale to migraine management. This could include leveraging different care team members to support PCPs, creating processes to refer patients to ongoing support within and outside the system, or increasing education and awareness of screening protocols to support diagnosis. The most efficient organizations will identify existing processes and resources that can work for their migraine strategy.    

Implementing new migraine strategies requires PCPs to be open to changing their behavior. Since they have a lot on their plates, skepticism among PCPs about process changes is understandable. Any system-wide migraine strategy must consider how to make changes easy for PCPs to adopt. Consider the following strategies:

• Embed nuanced migraine assessment and treatment tools into the electronic health record (EHR) that don’t make PCPs feel distracted or impeded when making a diagnosis. Consider an EHR-embedded tool that helps providers make treatment decisions and provides migraine diagnosis and treatment guidelines as needed. 
• Incorporate migraine-specific training into standing education sessions. 
• Ensure that migraine information is endorsed or delivered by a headache specialist or neurologist, as they are viewed as authorities for migraine guidance. 
• Enlist patients to be engaged and active in their own migraine management through patient education and symptom tracking tools so they come to appointments with information about the severity and frequency of their symptoms. 
• Evaluate strategies to deploy nursing staff and advanced practice providers (APPs), who may have more availability in their schedules than physicians. For example, to facilitate PCP capacity, assign patients with established diagnoses and treatment plans to an APP for ongoing care management.

Finding the right treatment plan for each patient can take time, and a lack of patient awareness about migraine diagnosis and treatment may cause further delays in care. Providing education materials early — either during triage via a nurse line, at the first primary care visit, or through the patient portal — can help patients describe their migraine experiences, advocate for proper migraine care, and reduce hesitancy to trying new treatments.

Patient education is also essential to any treatment plan that helps patients proactively manage their own condition, which boosts treatment adherence and improves patient outcomes. In addition to face-to-face education efforts, providers might use supplementary patient education materials, including:

• A digital or printed migraine treatment plan listing the patient’s acute and preventive medications, their potential side effects, and criteria for when to call their PCP.
• Migraine tracking tools, such as migraine diaries that track headache days, triggers, symptoms, and treatment effectiveness.
• Patient-centered videos or handouts with details about migraine symptoms and treatment.

Improving migraine care from diagnosis to management may seem overwhelming for health systems given the bulk of other responsibilities on their plate. This is why Pfizer and Optum developed a suite of resources to help health systems better diagnose and treat migraine throughout the care pathway with the Migraine Health System Toolkit.

How the Migraine Health System Toolkit addresses gaps in migraine care

Learn more about the Migraine Health System Toolkit.

Liam Frieswick, Michaela Dipillo, and Jennifer Fierke contributed to the writing of this case study.

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