In a presentation made last week at the 2015 meeting of the American Association of Nurse Practitioners, Theresa Mallick‐Searle, MS, RN‐BC, ANP‐BC, offered useful guidance to primary care clinicians to achieve better outcomes for their patients with migraine headache. Key among the recommendations is the taking of a thorough headache history, using a question set suggested by the mnemonic OLD CAARTS. Mallick-Searle observed that migraine remains undiagnosed and undertreated in up to 50% of patients with the condition, but that early treatment often leads to successful resolution.
Another area of confusion for many primary care clinicians who are assessing patients with headache is when to use imaging studies. Neuroimaging studies are not recommended for patients with stable headache who meet criteria for migraine, according to American Headache Society recommendations. If imaging is deemed necessary, the guidelines suggest that magnetic resonance imaging (MRI) is preferable to computed tomography (CT), except in emergency situations. Read a news report, with link to the presentation, here.