Migraine Treatment Strategies for Managed Care Pharmacists: Stratified Care Using the MIDAS Questionnaire

A majority of migraine headache sufferers experience moderate to severe disability from attacks, yet most are not effectively treated or satisfied with care. The Migraine Disability Assessment Scale (MIDAS) was developed to improve the detection of disabling migraine and to address some of the barriers migraine sufferers face in obtaining satisfactory care. The Disability in Strategies of Care (DISC) tested the hypothesis that using information about headache-related disability to select initial therapy would improve patient outcomes. The study compared stratified care, step care within attacks, and step care across attacks among 835 patients with MIDAS grades of II, III, or IV. Headache response at 2 hours was significantly greater for stratified care patients (52.7%), whose treatment was based on migraine severity, than in the step care across attacks (40.6%; p < 0.001) or the step care within attacks (36.4%; p < 0.001) groups. In our study, stratified care provided significantly better clinical outcomes than step care. Using the MIDAS questionnaire and the results of the DISC study, the pharmacist can play an important role in improving the care of migraine sufferers.