The role of headache-related disability in migraine management - Implications for headache treatment guidelines

Recently published US Headache Consortium Guidelines recommend a process of diagnosis, patient education, and individualized treatment for the managem ent of migraine. Clinicians are advised to base their treatment choice on a ttack frequency and duration, degree of disability, non-headache symptoms, patient preference, and prior history of treatment response, using a strati fied approach to care. In stratified care, initial treatment is individuali zed based on an assessment of the patients' medical needs. One approach to stratification uses the Migraine Disability Assessment (MIDAS) Questionnair e to stratify patients into groups with different treatment needs based on the degree of headache-related disability. Stratified care was developed as an alternative to step-care approaches, which begin patients on nonspecifi c medication with gradual escalation until they obtain effective relief. Re sults from the Disability in Strategies for Care (DISC) study indicate that stratified care provides superior outcomes compared to step-care and that the approach is cost-effective, supporting the US Headache Consortium Guide lines. Stratified care may become the approach of choice for managing migra ine in clinical practice. This approach increases the chances of providing appropriate therapy at the patient's initial consultation, sparing the pati ent a series of failed therapeutic efforts. The MIDAS Questionnaire provide s a practical tool for helping to implement the recommendations of the US H eadache Consortium Guidelines.