Development of Patient Defined Migraine Assessment Addie 1

Development of Patient Defined Migraine Assessment Addie 1 Wikowsky , Missouri State Erin M. 2 Buchanan , 1 University , Ryan 3 Cady , Heather 3 Manley , Harrisburg University of Science and 2 Technology , Purpose Migraine is a debilitating condition that impacts a multifaceted Phase One: Topics Important to Patients and Generated Questions set of factors for a person, including physical, productivity, Theme Freq. Sub-Categories social, and cognitive factors. One concern is that current Associated Symptoms 14 Decreasing frequency. Feelings, Symptoms popular assessment tools for migraine do not adequately view the patient as a whole for their treatment, and traditionally only Concentration 6 Focus, Clear head focus on only physical, pain-related items. Therefore, this project had two goals: first, to establish factors which are most Doctor 5 Access, More options important to patients when appraising the efficacy of headache treatment, and second, to develop a patient-reported outcome Education 19 Patient, Doctor, Family/Friends measure to evaluate meaningful response to headache treatment regimens, as defined by patients. Method Phase One This phase was designed to target our first research goal. An Licensed Professional Counselor on our team, Heather Manley, conducted a structured interview with ten participants. Each participant was compensated $200 for their time. The goal of this interview was to find out what topics were important to them when talking with their doctor about treatment plans. This interview included asking the participants their diagnosis, current and previous preventatives, and known triggers. Data from these interviews were coded so that the researchers can identify common concerns and facets that are important to individuals with migraines. These concerns included: cognitive concerns (concentration or brain fog), social connections (family or friends), emotions (self-worth), and day to day functioning (normal activities or productivity at work and home). Last, a set of provider specific options were coded, such as medication concerns, cost, insurance, and education of self and doctor as peripheral barriers to access of treatment Phase Two After discussing the ten participants responses from phase one, the researchers brainstormed questions to assess those topic areas. This phase was conducted to develop a questionnaire that could be used to assess response to treatment, and over 200 questions were generated for testing. 100 participants completed the new questionnaire. After receiving those answers, we used exploratory factor analyses (EFAs) on the different themes to examine the items. Questions were removed if they did not relate to their factor or receive a 75% patient approval rating. Then the top six questions were used from each of the remaining lists for reexamination in Phase Three (ongoing). Financial/Insurance 16 Cost of medication, Coverage Frequency 26 Number of days/headache, Less Pain Medication/Financial 23 Normal Functioning 48 Confidence in working, More options, Side effects/reliance Mood, Daily activities, Limitations Pain 21 Less pain, Headache free Productivity 26 Home, Work Self-Worth 14 Enjoyment, Feel productive/contributing Social 33 Family, Friends, Enjoyment Phase Two: Questions Examined with EFA Theme Associated Symptoms Concentration Doctor Education Financial/Insurance Frequency Medication/Financial Normal Functioning Pain Productivity Self-Worth Social Original Questions 13 9 13 15 17 19 22 27 17 24 14 20 High Loadings 8 7 13 10 16 17 14 27 13 17 12 16 Jim 3 Sly , Arielle 1 Cunningham Clinvest Research, 3 LLC Results Examples My other migraine symptoms such as light/sound sensitivity, or nausea have improved. During a migraine attack I find it difficult to concentrate on things that are important to me. My doctor helps me understand the full range of migraine symptoms. My medical provider is knowledgeable of migraine. It is easy for me to speak to my provider about my migraine. My friends understand my migraine symptoms and limitations. Adequate treatment of my migraine is a financial burden to me. I often delay treating a migraine with medication due to its cost. The number of days where I have a very severe migraine has decreased. I now have fewer migraine attacks. There adequate options available to me for effective migraine medications. I have confidence that when I take medication to treat a migraine it will work. I worry about being able to attend important events in my daily life. My activity level has increased because my migraine attacks have improved. I am improving because I have a reduced pain level. I am having head pain less often. I have been able to complete more daily tasks because I have less head pain. My migraines make me miss too much work. My migraine attacks decrease my feelings of self-worth. Migraine disease interferes with my life enjoyment. I have been able to schedule events with family and friends, which means I am improving. Discussion Important to Patients 7 6 13 10 15 17 13 19 13 10 6 8 This research indicates the need for a multifaceted questionnaire to adequately examine the factors related to migraine – and the development of such a scale would be beneficial to patients and doctors in understanding long term care. While traditionally viewed as a manageable disease, this research highlights the necessary need to view migraine as more than just head pain and to consider the psychological impacts on all aspects of a patient’s life. The last phase of this project will lead to a final short-form migraine questionnaire that can be used to assess response to treatment in the doctor’s office or at home for the patient. Potential applications include developing a phone app that would allow migraine sufferers to track their migraines, symptoms, and thoughts across days to share with their physician. Contact: Dr. Erin M. Buchanan (EBuchanan@Harrisburg. U. edu) Original questions indicates the number of items generated by the team. High loadings indicates items that correlated with their factor at >=. 30. This project was graciously supported by a grant from the National After eliminating these questions, the ratings of importance (yes/no) Headache Foundation. were examined, and items with less than 75% were excluded.