Delayed opportunities for patient-provider communication about medication overuse headache: Mixed methods perspectives from patients and neurologists.

Objectives: Medication overuse headache (MOH) is a common, debilitating condition occurring when migraine patients overuse pain relief medications. We conducted a convergent mixed methods study examining patient-provider communication on MOH.
Methods: Migraine patients were identified from one academic health center via electronic health records. Research staff recruited patients and administered a remote survey on MOH awareness, knowledge, and communication; descriptive and bivariate analyses were conducted. Neurologists from the same health center were invited to participate in qualitative interviews; analysis drew from the Rapid Identification of Themes from Audio Recordings procedures. A side-by-side comparison of results followed.
Results: Participants included 200 patients and 13 neurologists. More than one third of patients (39.5 %) had never heard of 'medication overuse headache.' Among those who had, 38.4 % learned about MOH ≥ 5 years after their migraine diagnosis. Neurologists similarly reported limited patient awareness of MOH and suggested communication was provider-initiated, reactive to patient-reported symptoms and behaviors. Participants agreed MOH was described as a 'consequence' of frequent medication taking, though specific terminology varied with neurologists suggesting they choose terms they perceive to be easier to understand and less stigmatizing to patients. Neurologists felt they lacked effective patient education resources.
Conclusions: Findings reveal delayed opportunities to inform patients about MOH. Standardized education supporting early preventive communication is needed, perhaps in primary care where many patients seek initial care for migraine symptoms.
Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Pack reports grants from Merck, Pfizer, Gilead, Gordon and Betty Moore Foundation, RRF Foundation for Aging, Lundbeck, and Eli Lilly through her institution, and personal fees from Gilead. Dr. Bailey reports grants from the NIH, Gilead, Merck, Pfizer, Gordon and Betty Moore Foundation, RRF Foundation for Aging, Lundbeck, and Eli Lilly via her institution and personal fees from Gilead, Sanofi, Pfizer, University of Westminster, Lundbeck, and Luto UK outside the submitted work. Ms. Herman is employed full time by Lundbeck and Dr. Kymes was employed full time by Lundbeck at the time of the research.
(© 2024 The Author(s).)