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Headache

Headache. Diagnosis and Management in Primary Care. Approaches to Treatment. Step care Staged care Stratified care. MIDAS Migraine Disability. Validated Sensitive to change, so good for follow-up Link to online version of MIDAS

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Headache

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  1. Headache Diagnosis and Management in Primary Care

  2. Approaches to Treatment • Step care • Staged care • Stratified care

  3. 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

  4. HIT-6 • Validated • Good for differential diagnosis • Scoring

  5. Negative LR Positive LR 0.8 0.4 0 Likelihood Ratiosfor diagnosis of migraine

  6. Overall Management Algorithm

  7. MIPCA Diagnostic Screening Algorithm

  8. 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?

  9. MIPCA Management Algorithm

  10. Close-up 1

  11. Close-up 1

  12. Migraine Prophylaxis...

  13. ...Migraine Prophylaxis

  14. Headache Action Plans My choice

  15. Meds Teaches

  16. Teaches

  17. Diary

  18. Diary

  19. Patient Handouts

  20. PowerChart Opportunities • Integrate Diagnosis decision aids into history-taking • Migraine Action Plan integrates PowerChart management orders with patient handout

  21. Migraine Action Plan Potential • Future patient feedback into chart • Recent HA pattern • Treatment response • Adverse effects

  22. Allergies & Intolerances sulfa > as a child penicillin > hives Imitrex SC > chest pain, anxiety (refuses to take again) Diagnoses Migraine Insomnia Hypothyroidism Cervical Dysplasia 2002 > cryo Dysthymia • Headache Pathway • Consult: Hx, Tx history, education, buy-in • Diagnosis: screen for HA type • Severity assessment: Frequency, Pain severity, Impact on pt’s life, Non-HA symptoms, Patient factors • Treatment Plan: Establish goals, Behavioral therapy, Acute therapy, Possible prophylactic therapy, Complementary therapy • Follow-up: Assess outcomes Paula Pound DOB: 02/11/1967 MRN: 99 88 77 66 5 ph 573-911-9876 email: ppound@cool.com Headache Dashboard • Medications • amitriptyline 10 mg 3 hs • Maxalt MLT 10 • Aleve 220 4 onset, 2 in 30 min • levothyroxine 125 mcg/d

  23. Allergies & Intolerances sulfa > as a child penicillin > hives Imitrex SC > chest pain, anxiety (refuses to take again) Diagnoses Migraine Insomnia Hypothyroidism Cervical Dysplasia 2002 > cryo Dysthymia • Headache Pathway • Consult: Hx, Tx history, education, buy-in • Diagnosis: screen for HA type • Severity assessment: Frequency, Pain severity, Impact on pt’s life, Non-HA symptoms, Patient factors • Treatment Plan: Establish goals, Behavioral therapy, Acute therapy, Possible prophylactic therapy, Complementary therapy • Follow-up: Assess outcomes Paula Pound DOB: 02/11/1967 MRN: 99 88 77 66 5 ph 573-911-9876 email: ppound@cool.com Headache Dashboard • Medications • amitriptyline 10 mg 3 hs • Maxalt MLT 10 • Aleve 220 4 onset, 2 in 30 min • levothyroxine 125 mcg/d Outcome measures Midas scores # HA / mo Missed work days Non-HA sx Tabular form for temporal trends Brought into PowerForm by nurse at checkin Drugs tried, failed, why Topamax Inderal

  24. Algorithm formatting question ... Allergies & Intolerances sulfa > 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 & Intolerances sulfa > 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 & Intolerances • sulfa > 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

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