This quality improvement project looked at prescribing of triptans in primary care in patients suffering from migraine. NICE guideline CG150 alert that a consumption of triptan for more than 10 days per month for 3 or more months, can develop medication overuse headache in this cohort of patients. Therefore, patients who were receiving more then 10 tablets of triptan per months in the last 4 months were identified and contacted.
The aim of the project was to identify patient suffering from medication overuse headache, review their treatment, provide education, discuss recommendations and changes in the treatment plan with patient and with the prescriber, implement the plan and feedback the doctors of the surgery on their prescribing trend. Medication overuse headache is an exclusion criteria for referring patient into secondary care according to the local headache pathway, therefore the project helped identify and stratify those patients and treating them with the benefits of improving their headache management or preparing them for a referral to secondary care once the MOH was resolved, avoiding unnecessary delays, and consequently, improving the local headache pathway and supporting secondary care.
128 patients were identified and 28% of them were receiving more than 10 tablets of triptans per month in the last 4 months, so selected to be contacted and reviewed. 84% of the patients contacted were suffering from medication overuse headache and an additional 10% were suspected to, demonstrating the pattern of prescribing was reflecting the pattern of medication assumption. 22.3% of the patients suffering from MOH were taking opioids, highlighting the lack of adherence to NICE recommendation to avoid opioids prescribing in migraine. Education was provided to the patients contacted to enable them to take control of their condition, suggesting useful tools like headache diary and increasing their knowledge of MOH, how to treat and how to avoid it, recognising that this was the first-time patients were informed of it. Missing documentation regarding OTC treatment was another important finding, and prescribers were briefed on the importance of documenting it in the consultation history. Strategies of alert for a referral based on the pattern of reordering of the acute treatment were discussed and implemented.
One year later, the same search was conducted in the same surgery and fewer patients were identified, demonstrating a quality improvement in the headache management of that patient cohort. Results were discussed with the local Clinical Commissioning Group."
