A review by the American College of Physicians found that no existing performance measure for migraine care is currently suitable for use and recommended no core performance measure.
The American College of Physicians (ACP) Performance Measurement Committee conducted a literature search to review clinical guidelines and existing measures of migraine. In the analysis, investigators focused on migraine care in US outpatient and internal medicine practice and evaluated measures based on validity, reliability, quality of evidence, importance, feasibility, and applicability rather than patient-level data. The primary objective was to determine whether a core performance measure for migraine treatment could be recommended, with secondary aims to assess existing measures, identify gaps, and evaluate whether guideline-based recommendations could be translated into measurable metrics.
The investigators identified just one existing measure: overuse of imaging for primary headache, included in the Merit-based Incentive Payment System. The investigators voted not to support this measure, citing lack of testing at the individual physician or group practice level, reliance in part on outdated guidelines, and limited exclusion criteria. The measure also showed minimal room for improvement, with average performance reported at less than 1%.
The investigators also evaluated a potential measure based on guideline-recommended treatment. A strong recommendation with moderate-certainty evidence supported adding a triptan to a nonsteroidal anti-inflammatory drug (NSAID) in nonpregnant patients with moderate to severe acute episodic migraine who don't respond adequately to NSAIDs. However, the investigators determined that this approach wasn't feasible as a performance measure. Over-the-counter NSAID use isn't reliably captured in electronic health records, making it difficult to define the eligible patient population and raising concern that such a measure would reflect documentation practices rather than care quality.
The findings highlighted broader limitations in migraine measurement. For instance, the investigators noted that care often depends on patient-reported symptoms and the use of nonprescription therapies, which are inconsistently documented. These gaps can limit the ability to develop measures that are valid and broadly applicable across clinical settings.
Key limitations included inadequate data capture, especially for over-the-counter drugs, a lack of testing for existing measures, and variability in documentation practices. These constraints affect both the reliability and feasibility of performance measurement in migraine care.
The ACP didn't recommend a core performance measure for migraine treatment, emphasizing that current limitations reflect measurement challenges rather than deficiencies in care.
“ACP does not support the only performance measure related to migraine because the measure specifications are based on outdated guidelines and are missing key exclusionary conditions,” wrote lead author Amir Qaseem, MD, PhD, MHA, of the ACP, and colleagues.
The study was funded by the ACP operating budget. Conflicts of interest were disclosed and managed; one contributor was recused because of a high-level conflict.
Source: Annals of Internal Medicine