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A critical key to managing migraine is effective patient education; ideally, we want to empower migraineurs to assume their share in management of the disorder with us—the physicians—serving as their consultants rather than caretakers. Inevitably, however, educating patients takes time and energy. While migraine diagnosis and formulation of a reasonable management plan rarely are difficult or time-consuming, the effort required to enable patients to buy into their diagnosis, understand migraine, adhere to management plans, and otherwise optimize implementation of those plans is substantial.

An important part of patient education involves physicians providing information about the therapies being prescribed. For example, we have an injectable drug for the treatment of acute migraine that is safe and effective for most patients, but many who use the drug may experience side effects such as chest pain or palpitations; while the side effects are typically benign, they can be extremely alarming to the uninformed. We need to explain carefully to each patient how to use this drug correctly and what they can expect with regard to side effects so that they won’t make needless trips to the hospital or cast the medicine away after a single use. An adequate explanation of this drug easily may require a large percentage of the time allotted for a clinic visit, and it’s only one of the many drugs used to treat migraine.

Headache Schools Add Value

Written materials intended to educate migraine patients as to their disorder and its management definitely can help, but their utility is limited. In the hopes of improving clinical outcomes and patient satisfaction through intense education, my colleagues and I at the University of South Alabama created a “headache school.” We selected articulate, personable, and intelligent migraine patients and put them through an intense training program involving didactic instruction and direct clinical experience. Our goal was to educate these individuals so they might serve as patient instructors. The instructors conducted three 90-minute teaching sessions. Specifically, the instructors defined migraine, and explained in detail how to treat migraine acutely and manage it chronically.

Data Support Effectiveness of Intense Patient Education Efforts

In 2006, we conducted a study to determine the utility of our “headache school.” We randomized 50 patients to “school” and 50 patients to “no school”; all subjects were treated in a uniform manner by physicians blinded to the randomized result. When assessed at 6 months, patients who went to “headache school” enjoyed a more favorable clinical outcome and were more satisfied with their degree of headache control. When tested, their understanding of migraine was greater than that of subjects randomized to “no school,” and they were more compliant with medications and follow-up visits. They made fewer phone calls to doctors about their headaches and fewer unscheduled visits to an emergency room or to another medical facility for acute headache treatment.

In our experience, the annual cost for operating a “headache school” is about $5,000—the bulk of that money used to pay stipends to instructors—and there’s little reason to believe that the cost would be substantially higher in other locations. The instructors typically are highly motivated patients themselves and are delighted to earn income helping others who suffer from the same condition. Thus, “headache school” is a relatively inexpensive intervention that has the potential to significantly improve public health.

Dr Rothrock has indicated to Physician’s Weekly that he has served as a paid consultant to Ortho-McNeil, GlaxoSmithKline, Merck & Co, Inc, Pfizer Inc, Pozen, and Allergan Inc. He has received research support from those companies and from Abbott Laboratories, Elan Corporation, Esai Inc, and AstraZeneca Pharmaceuticals LP. He hasalso received honoraria for lecturing from Ortho-McNeil, GlaxoSmithKline, Merck & Co, Inc, Pfizer Inc, Elan Corporation, and Endo Pharmaceuticals.