How New Zealanders rate health professionals seen for migraine
Results from the Migraine in Aotearoa New Zealand survey 2022
There hasn’t been much research in Aotearoa New Zealand into how much health professionals know about the diagnosis and optimal treatment of migraine. One study of emergency departments in Australia and New Zealand found that evidence-based treatment recommendations were not routinely followed, with missed opportunities to provide the most effective management to patients with moderate to severe migraine attacks.
Internationally, studies have shown that primary care physicians (general practitioners, GPs) lack knowledge about preventive treatments for migraine (including non-medication treatments) and lack confidence in prescribing them, and may be unaware that overuse of acute medications can cause headache. This means many people with migraine aren’t provided with all or any of the options to help them control attacks, which may increase their risk of progression to chronic migraine and medication overuse. Also, GPs who don’t have good information about managing migraine confess to a sense of ‘dread’ when confronted with a migraine patient, which can exacerbate the stigma associated with migraine disease.
In our 2022 Migraine in Aotearoa New Zealand Survey, we asked respondents to rate the knowledge of migraine and treatment options in the health professionals they had seen. (Those who had seen more than one were asked to rate the one seen most recently.) Possible responses were excellent, very good, good, fair and poor, with the option of indicating that the health professional hadn’t been seen, so the question wasn’t applicable. For this type of rating, ‘fair’ is considered barely satisfactory, and ‘poor’ definitely not satisfactory, with ‘good’ as the middling category and ‘very good’ or ‘excellent’ indicating a progressively higher appreciation and satisfaction with health professionals’ knowledge.
For 12 of the health professional types we asked about, at least 100 survey respondents provided a rating of their migraine knowledge. As previously reported, GPs were the health professional most commonly accessed for migraine treatment, but many other health and allied health professionals can be involved in the care of people with migraine.
For the health professionals most commonly seen for migraine, neurologists had the highest ratings for knowledge of migraine and treatment options, with over a third of survey respondents rating their knowledge ‘excellent’. Emergency departments and dentists fared worst, with around 50% of respondents rating their migraine knowledge as ‘fair’ or ‘poor’. For all health professionals, there is clear room for improvement.
For allied health, respondents consistently rated these professionals as more likely to have ‘fair’ or ‘poor’ migraine knowledge than ‘excellent’ or ‘very good’. Around 30% rated them as the middling ‘good’. Again, there is much scope for improvement.
We know there is relatively scant education about migraine given to medical students in New Zealand and probably even less to other health professionals. Migraine Foundation Aotearoa New Zealand is always looking for opportunities to provide information and education to health professionals and will continue to work in this area in collaboration with our clinical advisors.
In the meantime, we, the patients, must educate ourselves and take any chance to educate the health professionals we seek help from. If possible, we need to inform them about what migraine is (a neurological condition) and what it isn’t (just a headache). Check out our pamphlet, which summarises the basics of migraine disease – maybe print out a few copies for your health provider or suggest they have some available for other patients. Check out our overview of medications used for migraine, if your GP is unsure about treatment options.
Our goal is to transition all health professionals into excellent or very good migraine knowledge. Given how many people are affected by migraine in New Zealand, it is surely a reasonable ambition.
Chu, K., Kelly, A.-M., Kinnear, F., Keijzers, G. and Kamona, S. (2022), Primary headache drug treatment in emergency departments in Australia and New Zealand. Med J Aust. 2022 Oct; 217(7):366-7
Minen MT, Loder E, Tishler L, Silbersweig D. Migraine diagnosis and treatment: A knowledge and needs assessment among primary care providers. Cephalalgia. 2016 Apr;36(4):358-70
Minen MT, Robbins MS, Loder E, et al. Addressing the Crisis of Diagnosis and Management of Migraine in Primary Care: A Summary of the American Headache Society FrontLine Primary Care Advisory Board. Headache. 2020 May;60(5):1000-1004