TABLE 2
ISSUES RELATED TO CARE
| Physicians’ failure to take migraines seriously |
| “I remember the first doctor I went to. He said, ‘Oh, just take a couple of Tylenol and go on with it.’” |
| Desire for referral |
| “When you go to a clinic and they can’t help you, it’s like you’ve fallen off the face of the earth. Where do you go from there?” |
| Undesirable focus on medications |
| “I don’t want to be on a bunch of drugs. But they’re not willing to do anything else. If you can’t treat it with a chemical, you can’t treat it. Forget it!” |
| “I worry about getting pregnant. I’d like to make sure I have a healthy baby, so I don’t want to pollute myself. What if I’m already pregnant? Should I take a pregnancy test before I take my [name of drug]?” |
| Issues with drug companies |
| “I can’t afford to pay $75 to treat a headache, so sometimes I go without the medication. I only use it if it’s a severe one with the nausea and the vomiting.” |
Problems with insurance and drug companies
A great number of participants expressed anger with insurance and drug companies, viewing them as barriers to effective treatment. They were frustrated by “the bureaucrats” in managed care companies who mandated their choices of physicians and medications. This situation was particularly infuriating for those who had spent significant time and effort finding a physician with whom they felt comfortable or a medication that worked for them, only to be told that because of a change in insurance coverage, they had to change physicians, medications, or both. The primary complaint about pharmaceutical companies was the steep cost of medication.
Discussion
It is important to note this study’s limitations. The focus group format is an effective method for soliciting issues of greatest importance to the individuals in attendance, but does not provide information on the prevalence of those opinions in the population. Because patients experiencing up to 8 migraine days per month were included in the study, our sample may have included those who had obtained insufficient relief from treatment and were, therefore, dissatisfied with that treatment. The information provided in the discussions may have been influenced by the fact that individuals who volunteer to participate are likely to have different views from those who do not participate in such groups. The small sample size limits the authors’ ability to generalize about these findings. Thus, the experiences and views reported here cannot be considered representative of all migraine sufferers. Finally, patients report interactions with physicians as they remember them. In some cases, their recollections may not reflect the true nature of the interactions.
Nonetheless, these participants resemble the migraine sufferers most likely to seek headache treatment. The typical participant in this study, a white female aged 25 to 49 years who experiences 1 to 2 migraines per month, each lasting 1 to 2 days, is a counterpart to the migraine patient seen in the primary care setting. In fact, 60% of participants had consulted only in the primary care setting. Thus, the experiences and opinions reported here might be typical of migraine patients who present management difficulties for primary care physicians. Being aware of these patients’ concerns may help physicians provide more effective treatment and improve patient satisfaction.
Focus group members reported migraine-related concerns across a range of life experiences. These concerns can be divided into 2 primary categories: (1) impact of migraines on daily functioning and (2) perceived barriers to effective care.
The impact of migraines on quality of life has been well documented.2,5,12-20 Previous studies have shown that the bodily pain, nausea, and vomiting that occur during attacks result in impairments in job and role functioning.20 Migraines have also been shown to interfere with family and with social and recreational activities5—resulting in less pleasure in life and less energy between attacks—and to disturb sleep.18
Many of the problems of daily life that are encountered in experiencing frequent migraines, as reported by study participants, result from perceived barriers to treatment. Lipton and colleagues7 described 3 levels on which barriers occur: the failure of migraine sufferers to consult physicians, failure to receive correct diagnoses in those who do consult physicians, and failure of correctly diagnosed patients to receive effective therapy.
Participants’ comments reveal a fourth level on which barriers to effective migraine management can occur: correctly diagnosed consulters for whom effective treatment has been prescribed but who are unable or unwilling to implement the prescribed treatment. Among focus group participants were individuals who had consulted a physician, received the correct diagnosis, and obtained what is generally accepted as effective treatment. Yet some experienced difficulty in implementing that treatment.