Migraine Screening Is Not Common in Optometry Practice

Bao N. Nguyen, PhD

Data pulled from a cross-sectional survey revealed that a large number of optometrists do not currently use validated screening tools for migraine, highlighting the need for professional development in this area of care, as well as an opportunity to do so.

Bao N. Nguyen, PhD, lecturer, department of optometry and vision sciences, University of Melbourne, and colleagues performed a cross-sectional study to assess optometrists’ knowledge and behaviors about migraine screening and willingness to participate in a pilot implementation program for a 3-item validated migraine screening questionnaire called the ID-Migraine. Those who provided their contact details were invited to watch an online educational resource about the validated migraine screening tool as well as participate in a follow-up cohort study after 6 weeks to assess the effectiveness of the educational resource.

Among the 98 optometrists included in the study, 79 (91%) claimed that they actively asked patients about migraine as part of routine eye examinations and 71 of 98 respondents (72%) self-rated themselves as confident in identifying migraine. However, 90 of 98 respondents (92%) were not aware of any validated migraine screening tools and 93 of those reported not using a validated screening tool for migraine at all.

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“We demonstrate the feasibility of educating optometrists, as primary care clinicians, on the importance and utility of a validated migraine screening tool with a relatively simplistic, low-time investment intervention. Such education may result in improved identification of migraine among primary eye care clinicians, which may in turn lead to improved management of migraine sufferers,” Nguyen and colleagues concluded.

Those who did not report the current use of a validated screening tool for migraine were asked, “how do you determine if a patient may have migraine?” The responses from optometrists showed that the majority asked about symptomology (59 of 93 respondents; 64%) or patient demographics such as age, gender, or family history (14 of 92 respondents; 15%). Less commonly, the optometrists surveyed relied on a previous physicians diagnosis of migraine, or referral to a physician for diagnosis (8 of 92 respondents; 9%), patient’s self-report of migraine (7 of 92 respondents; 2%) or the International Classification of Headache Disorders (2 of 92 respondents; 2%) to ascertain whether a patient may have migraine.

The lack of optometrists including validated migraine screening tools was a troubling signal, as 78 respondents provided their contact details to receive information about the subsequent cohort study. Thirty-one of the 78 respondents (40%) completed the follow-up survey, with a growing number of the responses being positive.

Fourteen of the 31 participants (45%) self-reported using the ID-Migraine tool since watching the educational video, with the frequency of use ranging from once in 4 weeks (0.25 times/week) to 5 times per week (median [interquartile range (IQR)] = 2.25 times/week). Among those who used the ID-Migraine tool, 12 of the 14 respondents (86%) were likely or extremely likely to use the tool again in their clinical practice. Additionally, 22 of the 31 respondents (71%) claimed they would recommend watching the educational resource on the screening tool to other optometry colleagues.

As for the 17 respondents who did not incorporate the ID-Migraine tool into their standard care, “I forgot to use the migraine screening tool” was the most commonly agreed reason (9 of 17 respondents; 53%). Non-mandatory requirement for optometrists was the second most commonly agreed reason (7 of 17 respondents; 41%) and learning more about migraine and headache before making the decision to incorporate it was third most commonly agreed reason for not adding the ID-Migraine tool (6 of 17 respondents; 35%).

Kathleen Digre, MD, distinguished professor of neurology and ophthalmology at the John A. Moran Eye Center, chief of the Division of Headache and Neuro-ophthalmology at the University of Utah in Salt Lake City, recently discussed the impact of eye pain and photophobia in patients with migraine with NeurologyLive. “Every ophthalmologist needs to know about migraine and realize that migraine could participate in eye pain and light sensitivity that their patients see. They should recognize it, say yes, this happens and get them to a place that that they can get help,” Digre said.

REFERENCE

Nguyen BN, Singh S, Downie LE, McKendrick AM. Migraine screening in primary care practice: current behaviors and the impact of clinician education. Headache. Published online August 7, 2020. doi: 10.1111/head.13920