Better patient interviews may aid migraine treatment.

SCOTTSDALE, ARIZ. -- Open-ended questions during patient interviews elicit the best information for guiding the management of patients with migraine headache, Dr. Richard B. Lipton said at a symposium sponsored by the American Headache Society.

Yet closed-end questions focusing on headache triggers, frequency, and symptoms comprised most of the dialogue between physicians and migraine headache patients, based on the American Migraine Communications Study (AMCS). And the patient and physician often differed in their assessments of headache frequency, disability, and impairment, said Dr. Lipton, who is professor of neurology at the Albert Einstein College of Medicine, New York.

Patients and physicians really weren't hearing and understanding each other during the office visit, he said. As a result of these miscommunications, physicians underappreciated the need for preventive treatment and patients had incomplete knowledge about medication use and inappropriate expectations of their outcomes.

The AMCS findings were based on analyses of videotaped encounters with 60 patients (80% women, mean age 42 years) and a geographically representative sample of 14 primary care physicians and 8 neurologists. The average duration of migraines was 14 years with a frequency of five episodes per month.

Dr. Lipton and his coinvestigator Dr. Steven R. Hahn analyzed the structure of questions posed during the recorded physician-patient interviews. Closed-ended questions allowed patients to make selections, while open-ended questions encouraged more wide-ranging dialogue. A typical closed-end question, for example, was: 'Are the headaches on one side of your head or bilateral?" An example of an open-ended question would be: "Tell me about your headaches."

Framing the interview with closed-ended questions gleans only limited information, said Dr. Hahn, professor of clinical medicine at Albert Einstein. "Open-ended questions are the foundation of patient-centered interviewing, and they allow patients to recount their symptoms in the narrative context, focusing on the things that are most important to them."

Based on assessments after the interviews, 35 of the 60 patients were not receiving any therapy for their disabling headaches. The other 25 had been prescribed an average of two drugs, primarily triptans, but many did not have an accurate understanding of how to use the drugs or what they could reasonably expect from drug therapy.

Overall, "55% of physicians and patients were misaligned on migraine frequency post visit, which is amazing to me. It seems to me that the question of how many headache days occur over a 3-month period would be something patients and physicians could agree on," Dr. Lipton said.

Dr. Lipton and Dr. Hahn recommend an "ask, tell, ask" approach. First, ask the patient about the number of headache days. Then repeat what you have heard. Finally, ask whether you have stated the situation correctly.

The "ask, tell, ask" technique improves communication and thus will improve treatment, Dr. Lipton concluded.

BY BRUCE K. DIXON

Chicago Bureau