Objective:

To identify Veterans Health Administration (VHA) primary care providers’ (PCPs) perspectives regarding headache evaluation, treatment and management while seeking to understand areas that can enhance the headache care delivered within primary care settings.

Background:

As first point of contact for patients with headache disorders, primary care plays a critical role in headache diagnosis, management and education for those living with migraine and other headache diseases.

Design/Methods:

PCPs at VHA facilities were surveyed across the US and offered a virtual follow-up qualitative interview. The Consolidated Framework for Implementation Science (CFIR) inner and outer setting domains guided interview questions. Rapid Qualitative Analysis was used to identify analysis domains, content and recommendations.

Results:

Twelve primary care providers averaging 11.6 years of experience were interviewed following survey completion. Most had no formal headache training and are unfamiliar with the newest medications. All expressed some comfort diagnosing and treating migraine and tension headaches, seeking specialist e-consults as needed. Participants prescribe acute and preventive headache medications, provide patient education around medications and lifestyle modifications, and offer referrals to acupuncture, chiropractic, and mental health services. For treatment failures and more complex headache, they typically refer to specialists. All expressed interest in having a standardized order set within the electronic health record (EHR), and participating in education especially about treatment options, preferring real-time interactive modalities along with on-demand modules. PCPs described treatment barriers related to navigating specialty referrals, patient travel, rurality and insufficient access to headache specialists.

Conclusions:

Participating VHA PCPs routinely diagnose and manage common headache types, prescribe pharmacologic and non-pharmacologic treatments, and deliver education and lifestyle counseling. PCPs will seek referrals for more complex headache disease, noting several challenges with headache specialty referrals. EHR-embedded tools and various educational initiatives were suggested options to improve the delivery of guideline-concordant headache treatment delivered within primary care.