Migraine Screening in Primary Eye Care Practice: Current Behaviors and the Impact of Clinician Education.

Abstract

Migraine is underdiagnosed and undertreated. Optometrists are primary eye care providers, who regularly encounter people with migraine as an incidental finding during routine eye examinations, or when patients present to rule out whether visual or ocular problems are contributing to headache symptoms. Knowledge and use of a migraine screening tool in optometric practice is, therefore, important to be able to identify and refer people with migraine for appropriate management. We sought to investigate optometrists' current behaviors regarding screening for migraine, and to assess the effectiveness of an educational resource in promoting the use of a 3-item validated migraine screening questionnaire, the ID-Migraine. We first conducted a cross-sectional study using a survey to assess optometrists' current knowledge and behaviors about migraine screening and willingness to participate in a pilot implementation program. Participants who provided their contact details were invited to watch an online educational resource about a validated migraine screening tool. After 6 weeks, these participants were invited to participate in a follow-up cohort study involving a survey to assess the effectiveness of the educational resource. Ninety-eight optometrists completed the initial survey as part of the cross-sectional study. We found that most optometrists actively asked patients about migraine (79/98 respondents, 81%) as part of routine eye examinations and self-rated themselves as confident in identifying migraine (71/98 respondents, 72%). However, the majority (90/98 respondents, 92%) were not aware of any validated migraine screening tools. Seventy-eight respondents provided their contact details to receive information about the subsequent cohort study. In response to the follow-up study survey (31/78 participants, 40%), 45% (14/31 respondents) of participants self-reported using the ID-Migraine tool after watching our educational video, and most of these participants (12/14 respondents, 86%) were likely or extremely likely to continue to use the tool in their practice. From our initial cross-sectional survey, we conclude that optometrists do not currently use validated screening tools for migraine and as such, there is an opportunity for continuing professional development in this area. Our follow-up cohort study demonstrates that educating optometrists on the importance and utility of a validated migraine screening tool is achievable with a relatively simple, low-time investment intervention (an online educational video). Such education may result in improved identification of migraine, which may lead to improved management.