Management of Chronic Headache in Primary Care Clients with Mental Health Conditions

Abstract

Purpose: Chronic headache management practices of primary care providers (PCPs) within a specific organization were assessed. The participants were exposed to select headache management strategies for use with and without coexisting treatment for mental health conditions, with the intention that provider confidence in chronic headache management would improve. Background Many practice aids used in headache care are based on the International Classification of Headache Disorders (ICHD-3). Migraine, tension type, and medication overuse headaches are three commonly diagnosed types. Screening tools help narrow diagnostic possibilities alongside the history and physical examination. Some headache treatments overlap with treatments used in managing mental health dispositions, narrowing treatment options in some cases. Methods A modified dissemination and implementation model guided this project and was provided as a resource for the participating organization. A pre-intervention survey, an informational presentation, and a post-intervention survey were utilized. The initial survey measured existing knowledge on management of chronic headaches. The presentation outlined pertinent resources and guidelines for maintaining a standardized headache management protocol. The post-intervention survey elicited participant readiness to employ the offered resources. Results Three respondents estimated 1-20% of their patients experienced chronic headaches, and four estimated 21-40%. Two estimated 1-20% have continuous difficulty achieving acceptable relief, one estimated 21-40%, and four estimated 41-60%. Four estimated 1-20% had required neurology for an atypical presentation, and three estimated 21-40%. Mean comfort level from 0-10 with diagnosing a specific primary headache type and developing an individualized management plan was 5.38 pre-presentation, and 7.14 postpresentation. All seven stated management of chronic headaches in primary care without routine neurology consultation was feasible. One respondent had previously prescribed CGRP inhibitors, six had not. Postpresentation, six affirmed they would use the ICHD-3. Six anticipated treating with CGRP inhibitors in the future. Four stated the HARDSHIP, HALT, and HURT tools were feasible for their use. HeadApp for journaling was of interest to five participants. Conclusion Introducing an informational voiceover presentation, clinical practice guidelines, and decision support tools into the participating clinical environment served to bolster mean confidence overall. Yet 43% of clinicians suggested the screening tools themselves were unlikely to affect their practice.