Interventions and Outcomes Management in Migraine

Migraine is a common chronic headache disorder affecting more than 10% of persons in Western populations. The clinical management of migraine is notable for the variability of diagnostic testing, therapeutic interventions and cost. Standards of care and clinical guidelines for migraine have recently been published or are currently under development. For these reasons, migraine is an ideal disease for a disease management programme. This article outlines the key concepts in developing a disease management programme for migraine which include: setting appropriate goals of migraine disease management; identifying patients for enrolment; providing critical components of care; instituting appropriate referral guidelines; and using continuous quality improvement methods to reach desired goals. Appropriate goals of migraine disease management should focus on decreasing migraine frequency and/or severity and improving quality of life for individuals who experience migraine. Additional goals may include reducing: overall cost to the organisation; pharmacy costs for migraine therapies; and emergency department and urgent care patient visits. Methods for identifying patients for enrolment in a migraine disease management programme include screening patients in various clinical settings, reviewing pharmacy records or self-enrolment. Key components of care include diagnostic and treatment algorithms, instruments to monitor quality of life, and education programmes for practitioners and patients. The final step in designing a disease management approach to migraine is to ensure that the process is continuously undergoing analysis and improvement.