Improving chronic migraine assessment in primary care: a quality improvement project

Abstract

Background: Migraine is a leading cause of disability, yet standardized assessment tools are underutilized in primary care settings. The MIDAS (Migraine Disability Assessment Scale) offers a structured approach to evaluating migraine-related disability, but its integration into clinical practice remains inconsistent. Local Problem: A small primary care clinic and urgent care in Montana lacked a standardized approach to assessing migraine impact, limiting effective treatment planning. Prior to the intervention, 0% of migraine patients had a documented disability assessment, and provider confidence in using disability-based tools was low. Methods: Participants included primary care providers (PCPs) and adult patients diagnosed with migraines. Over a six-week quality improvement (QI) initiative, provider education and the use of the MIDAS tool were implemented. Outcomes were measured biweekly, including provider confidence in assessing migraine-related disability, the percentage of eligible patients receiving MIDAS screening, and treatment modifications based on MIDAS scores. Intervention: Providers viewed and completed an educational session covering migraine pathophysiology, treatment options, and the role of the MIDAS tool. The screening tool was integrated into practice with patients with a chief complaint of headache or migraine. Structured guidance on interpreting results and optimizing treatment plans for chronic migraine patients was provided. Results: Among 35 eligible patients, 43% (n=15) received MIDAS screening, a significant improvement from baseline (0%). Provider-reported confidence in using the tool increased by 100%. Of those with moderate to severe disability (MIDAS score > or = 11), 70% (n=7) had treatment modifications, including 50% (n=5) receiving preventive therapy adjustments. Patient-reported quality of life scores improved by an average of 33% over six weeks. Conclusion: Standardizing migraine disability assessment with the MIDAS tool improved provider confidence, guided treatment adjustments, and enhanced patient outcomes. Long-term follow-up is needed to evaluate sustained integration and impact.