Migraine Diagnosis and Treatment: A Knowledge and Needs Assessment of Women's Healthcare Providers

Allison M. S. Verhaak PhD; Anne Williamson PhD; Amy Johnson MD; Andrea Murphy APRN; Matthew Saidel MD; Abigail L. Chua DO; Mia Minen MD, MPH; Brian M. Grosberg MD


Headache. 2021;61(1):69-79. 

In This Article


The knowledge and needs assessment was conducted with select women's healthcare providers in Connecticut, using a modified version of the survey developed by Minen et al for PCPs.[17] Specifically, the survey was expanded to include a series of questions related to hormone therapy in the context of migraine, in addition to the original survey which queried provider knowledge of treatment guidelines, practice patterns, referral patterns, non-pharmacological treatments of migraine, and headache educational needs (see Appendix for full survey). The survey was reviewed for clarity and appropriateness of questions by board-certified headache specialists and a board-certified obstetrician/gynecologist. The project was determined to be a quality improvement effort by the Hartford Hospital Human Subject Protection Program, and was therefore exempt from IRB review, and requirement for written informed consent was waived.

Participants and Comprehensive Survey

The survey was created in Research Electronic Data Capture (REDCap) and distributed via email to women's healthcare practices throughout Connecticut, including academic medical centers, healthcare systems, and private practices. Individuals within each organization were identified and asked to email the REDCap survey link to their clinical colleagues, to ensure widespread internal distribution among email listservs. All individuals approached with this request agreed to distribute the REDCap survey link. Provider groups were primarily physicians (including obstetrics/gynecology residents or fellows), as well as advanced practice registered nurses (APRNs), physician assistants, and certified nurse midwives. It is estimated that approximately 402 providers were invited to participate in the web-based survey; this number is an estimate only, due to ongoing staff changes during the survey open period. To be eligible for participation, respondents had to be prescribing, clinical providers. The survey was open to new respondents in April 2018, and remained open for approximately 3 months. One email reminder was sent 1 month after the survey was opened, by the identified individuals at each program who sent the original study email. Because the survey link was sent to select individuals for subsequent widespread dissemination, response rate determination is an approximation. No incentives were offered for completion of the survey.

Statistical Analysis

Data were collected by REDCap, and the following primary analyses were performed using the statistical software IBM SPSS for Windows, version 23. Results pertaining to provider knowledge and needs assessment were descriptive in nature. Specifically, mean, standard deviation, and frequency/percentage were calculated for survey item responses. Additional post hoc analyses were conducted to explore provider differences in practice patterns, based on what percentage (%) of their patients for which they serve as PCP. Specific variables explored in this post hoc analysis included provider-specific variables (provider level of training), as well as variables related to practice patterns (comfort diagnosing migraine; comfort prescribing medications for migraine; use of preventative medications; and use of stepwise treatment plans). Separate between-subjects, one-way analysis of variance (ANOVA) tests were conducted for the above variables. Post hoc tests (Tukey's) were used to examine pairwise group differences, as appropriate. Hypothesis testing was two-tailed. The level of significance was set at p < 0.01 to account for multiple comparisons. No statistical power calculation was conducted prior to the study, and the sample size was based on the available data for respondents who completed the survey during the 3-month window.