Expert Insight

3 takeaways on why primary care is key to migraine management

Migraine management is a crucial aspect of primary care, but it often falls short due to gaps in diagnosis and treatment. Discover why standardizing migraine workflows, making it easier for primary care providers to participate in migraine care, and empowering patients to play an active role are all essential for improving migraine outcomes.

It is estimated that 40 million people in the U.S. suffer from migraine.1 Though common, migraine is one of the most underdiagnosed and undertreated neurologic conditions, in part because there is no diagnostic lab test for migraine.2,3 Migraine is the second most common cause for disability outside of low back pain4 and costs the U.S. economy an estimated $78 billion per year.5 In addition, there are fewer than 700 certified headache specialists in the United States.6 In April 2024, migraine management experts met to discuss how to improve the diagnosis and treatment of migraine in the primary care setting. Read on for three key takeaways from the Advisory Board webcast, Why primary care is the missing piece in migraine management.

Key takeaways

1. To improve migraine care, we need to standardize migraine workflows in health systems.

Since patient and health system challenges may exist along the migraine care journey, health systems will need to analyze the current diagnostic, treatment, management, and referral approaches, and then evaluate where gaps in care may exist.2

For example, migraine patients are often diagnosed by their primary care provider (PCP). While PCPs are usually the first point of contact for people with migraine, many haven’t received comprehensive training in migraine management and there is no easy diagnostic lab test.3 As a result, they don’t always feel confident diagnosing, treating, and managing migraine.7

In addition, primary care clinics may not be set up to support migraine diagnosis and treatment. For instance, a single yearly appointment doesn’t give PCPs time to gather a full history of migraine symptoms and treatment attempts,8 and the physical exam itself is unlikely to reveal migraine. On top of that, diagnostic criteria for migraine are typically developed for headache specialists and neurologists, so it can be difficult to determine how to apply them in a primary care setting.

When PCPs aren’t confident in confirming or treating a migraine diagnosis, they often refer patients to a specialist. But there aren’t enough headache specialists or neurologists to sustainably handle all migraine patients without strain on the healthcare system. Choosing to refer most or all migraine patients to specialists can leave patients waiting months before their pain is addressed.9

“There aren’t a lot of educational efforts to train the primary care physicians in migraine. Consequently, PCPs have not traditionally taken ownership for this disease.”

- Vincent Martin, MD
University of Cincinnati, Gardner Neuroscience Institute

Rather than reinventing the wheel, apply validated primary care protocols and experience in chronic disease management to migraine management.

2. Primary care needs to be a bigger part of migraine care, but to do that, health systems must make caring for migraine patients easier.

To truly improve the outcomes of migraine care, health organizations must make it easier for PCPs to participate in change. Supporting PCPs with education, standardized workflow, and supporting resources can minimize additional clinical and administrative burden to an already overburdened PCP practice.2,10

“If you screen patients in a primary care waiting room, the prevalence of migraine is anywhere from 28% to 34%. Migraine tends to be overrepresented in primary care offices.”

- Vincent Martin, MD
University of Cincinnati, Gardner Neuroscience Institute

Integrate standardized migraine tools into the primary care workflow. While no diagnostic test can positively identify migraine,3 a variety of migraine tools are available to help PCPs narrow down a diagnosis and consider available treatments. Tools might include an overview of acute and preventive treatment options, migraine diaries to assess how patients are experiencing migraines over time, and screening tools like ID Migraine. Some tools may be programmed into the electronic health record (EHR) so that PCPs can easily select evaluation questions to ask patients, be quickly educated on symptoms that require a referral, and prescribe medications.

Give PCPs time to learn about migraine diagnosis and treatment. Relying on grand rounds to educate PCPs about migraine is not enough. In addition to granting providers access to education from the National Headache Foundation and other organizations, health systems can create alternative forms of learning. For example, organizations might give PCPs time to do a preceptorship where they spend a half day every week in a headache specialist’s office for several weeks. Or, organizations could organize interactive lunch-and-learn events where PCPs can listen to a 15-minute lecture on migraine diagnosis, acute therapies, and preventive therapies.

Because PCPs are already overburdened, embed new migraine strategies that make it easier to manage migraines. Embed validated tools to support initial diagnosis and ongoing management of migraine patients.

3. Patients must play an active role in their own migraine diagnosis, treatment, and management.

Empowering patients to play a role in their migraine management can encourage patient adherence to prescribed treatments and make management easier for PCPs.2,8

In tandem with learning via provider education, PCPs can create “therapeutic alliances” with patients by establishing a framework to talk about migraine. Once a patient is diagnosed with migraine, a provider in the clinic may educate patients about the role of urgent care, the ER, and telehealth in managing migraine attacks. Patients can also learn about acute and preventive treatments for migraine and how to track the frequency and severity of migraine symptoms.

“It’s important to have an established communication plan to ensure that patients are getting the most out of their therapy. And if it’s not working, then they come back in and have a conversation with their provider to reassess.”

- Heather Nelson, Health Systems Migraine Lead
Pfizer, Inc.

Help patients participate in managing their migraines by educating early and often.

Migraine management plans are based on patient history and responses to treatment. Providing education materials early — either during triage via a nurse line, at the first primary care visit, or through the patient portal — can help patients describe their migraine experiences, advocate for proper migraine care, and alleviate hesitancy to try new treatments.

Learn more about how the Migraine Health System Toolkit addresses gaps in migraine care.

1Law HZ, Chung MH, Nissan G, Janis JE, Amirlak B. Hospital Burden of Migraine in United States Adults: A 15-year National Inpatient Sample Analysis. April 23, 2020.

2 Note: Unless otherwise specified, the information in this piece came from the expert panel discussion on the Advisory Board webcast, Why primary care is the missing piece in migraine management, April 3, 2024.

3 Durham PL. CGRP-Receptor Antagonists – a Fresh Approach to Migraine Therapy? N Engl J Med. March 11, 2004.

4 Steiner TJ, Stovner LJ, Jensen R, et al. Migraine remains second among the world's causes of disability, and first among young women: findings from GBD2019. J Headache Pain. December, 2020.

5 Gooch CL, Pracht E, Borenstein AR. The Burden of Neurological Disease in the United States: A Summary Report and Call to Action. Ann Neurol. April 2017.

6 April 2022 Society Spotlight. American Headache Society. April 13, 2022.

7 Verhaak AMS, Williamson A, Johnson A, et al. Migraine diagnosis and treatment: A knowledge and needs assessment of women’s healthcare providers. Headache. December 30, 2020.

8 Martin VT, Feoktistov S, and Solomon GD. A rational approach to migraine diagnosis and management in primary care. Ann Med. October 29, 2021.

9 Optum interviews with Optum providers.

10 Minen M, Shome A, Halpern A, et al. A migraine management training program for primary care providers: An overview of a survey and pilot study findings, lessons learned, and considerations for further research. Headache. April 1, 2016.

About the presenters

Vincent Martin, MD

Director of the Headache and Facial Pain Center at the University of Cincinnati Gardner Neuroscience Institute.

Dr. Martin is the Director of the Headache and Facial Pain Center at the University of Cincinnati Gardner Neuroscience Institute.  He is also the Professor of Clinical Medicine in the Division of Internal Medicine as well as the President of the National Headache Foundation.

Heather Nelson

Health Systems Lead, Migraine Market Shaping Team, Pfizer Inc.

Heather is currently focused on uncovering opportunities to improve care gaps for migraine patients within health systems as a member of Pfizer’s Market Shaping Team. She has worked in healthcare for over 22 years and held roles in sales, account management, operations and team leadership.  Heather has a passion for cross functional collaboration and improving patient outcomes through quality improvement.

Heather graduated from the University of Wisconsin-Madison with a Bachelor's degree in Biochemistry and Nutritional Science.

About the sponsor

At Pfizer, we apply science and our global resources to bring therapies to people that extend and significantly improve their lives. We strive to set the standard for quality, safety and value in the discovery, development and manufacture of health care products, including innovative medicines and vaccines. Every day, Pfizer colleagues work across developed and emerging markets to advance wellness, prevention, treatments and cures that challenge the most feared diseases of our time. Consistent with our responsibility as one of the world's premier innovative biopharmaceutical companies, we collaborate with health care providers, governments and local communities to support and expand access to reliable, affordable health care around the world. For more than 170 years, we have worked to make a difference for all who rely on us.

We routinely post information that may be important to investors on our website at

To learn more, please visit us and follow us on Twitter at @Pfizer and @Pfizer News, LinkedIn, YouTube and like us on Facebook at

Sponsored by

This article is sponsored by Pfizer. Advisory Board experts wrote the article, and conducted the underlying research independently and objectively. Pfizer had the opportunity to review the article.

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