Neurologist-Patient Dialogues About Chronic Migraine Lacking Crucial Elements

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Neurologists were asked to submit 2 to 3 recordings of routinely scheduled, naturally occurring headache visits per month.
Neurologists were asked to submit 2 to 3 recordings of routinely scheduled, naturally occurring headache visits per month.

Dialogues between neurologists and individuals with chronic migraine during routinely scheduled office visits do not cover crucial elements for diagnosis and treatment or use standard communication techniques that may improve reported outcomes, according to a prospective, observational study published in Headache: The Journal of Head and Face Pain.

The study invited 20 neurologists from a U.S. neurology panel to record their clinical encounters with patients with chronic migraine. Of those invited, 14 neurologists accepted the invitation to participate in the study, resulting in 35 recorded encounters that included both new client visits and follow-up visits. The encounters were audio-recorded, anonymized, transcribed, and analyzed by a sociolinguist. The sociolinguist listened for pre-specified communication parameters, strategies, and language that would indicated optimal migraine-related medical care.

The analysis of the audio recordings revealed 82% of questions asked during the encounter were closed-ended (369/450), with 17 headache-related questions per visit on average. Only a single dialogue assessed headache days per month and only 22.9% of the dialogues (8/35) discussed headache-related disability, both crucial elements for diagnosis and treatment. For standard communication techniques, only 1 neurologist used open-ended questions and only 1 utilized the ask-tell-ask technique. Treatment plans were discussed in 37.1% of the recorded dialogues (13/35).

The results from the preliminary study show that dialogues between neurologists and individuals with chronic migraine are lacking crucial elements that may improve diagnostic accuracy and treatment decisions. Chronic migraine is under-diagnosed and under-treated, so effective medical communication is an essential component of medical care in order to provide people with accurate diagnoses and effective treatment plans. The benefits of improved communication during routine office care should be assessed in further interventional studies.

This study was sponsored by Allergan plc.

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Reference

Buse DC, Gillard P, Arctander K, Kuang AW, Lipton RB. Assessing physician-patient dialogues about chronic migraine during routine office visits [published online May 4, 2018]. Headache. doi:10.1111/head.13314

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