Date post: | 23-Dec-2015 |
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MIDASMigraine Disability
•Validated
•Sensitive to change, so good for follow-up
•Link to online version of MIDAS
•http://www.migraine-disability.net/About_Midas/questionnaire5.pdf
HIT-6
•Validated
•Good for differential diagnosis
•Scoring
Mild impairment 50-55Moderate 56-59Severe ≥60
MIPCA Diagnostic Screening Algorithm•Can we make that
algorithm operate in the background and suggest steps in the Plan?
•Hook it to a Headache Condition Summary?
PowerChart Opportunities
•Integrate Diagnosis decision aids into history-taking
•Migraine Action Plan integrates PowerChart management orders with patient handout
Migraine Action Plan Potential
•Future patient feedback into chart
•Recent HA pattern
•Treatment response
•Adverse effects
Headache Dashboard
• Medications
• amitriptyline 10 mg 3 hs
• Maxalt MLT 10
• Aleve 220 4 onset, 2 in 30 min
• levothyroxine 125 mcg/d
DiagnosesMigraineInsomniaHypothyroidismCervical Dysplasia 2002 > cryoDysthymia
Allergies & Intolerancessulfa > as a childpenicillin > hivesImitrex SC > chest pain, anxiety (refuses to take again)
Headache Pathway1.Consult: Hx, Tx history, education, buy-in2.Diagnosis: screen for HA type3.Severity assessment: Frequency, Pain severity, Impact on pt’s life, Non-HA symptoms, Patient factors4.Treatment Plan: Establish goals, Behavioral therapy, Acute therapy, Possible prophylactic therapy, Complementary therapy5.Follow-up: Assess outcomes
Paula Pound DOB: 02/11/1967 MRN: 99 88 77 66 5 ph 573-911-9876 email: [email protected]
Headache DiaryHeadache 1 Headache 2 Headache 3
Date / time
Prodrome / aura
Pain (1-10)
Location / type of pain
Other symptoms
Possible triggers
Meds taken
Did med help?
Med side effects
Other therapies
Did another tx help?
Headache Dashboard
• Medications
• amitriptyline 10 mg 3 hs
• Maxalt MLT 10
• Aleve 220 4 onset, 2 in 30 min
• levothyroxine 125 mcg/d
DiagnosesMigraineInsomniaHypothyroidismCervical Dysplasia 2002 > cryoDysthymia
Allergies & Intolerancessulfa > as a childpenicillin > hivesImitrex SC > chest pain, anxiety (refuses to take again)
Headache Pathway1.Consult: Hx, Tx history, education, buy-in2.Diagnosis: screen for HA type3.Severity assessment: Frequency, Pain severity, Impact on pt’s life, Non-HA symptoms, Patient factors4.Treatment Plan: Establish goals, Behavioral therapy, Acute therapy, Possible prophylactic therapy, Complementary therapy5.Follow-up: Assess outcomes
Paula Pound DOB: 02/11/1967 MRN: 99 88 77 66 5 ph 573-911-9876 email: [email protected]
Outcome measuresMidas scores# HA / moMissed work daysNon-HA sxTabular form for temporal trendsBrought into PowerForm by nurse at checkin
Drugs tried, failed, whyTopamaxInderal
Allergies & Intolerancessulfa > as a child Imitrex SC > chest pain, anxiety (refuses to take again)penicillin > hives
Allergies & Intolerancessulfa > as a child
Imitrex SC > chest pain, anxiety (refuses to take again)penicillin > hives
Allergies & Intolerances•sulfa > as a child•Imitrex SC > chest pain, anxiety (refuses to take again)•penicillin > hives
Allergies & Intolerancessulfa > as a childImitrex SC > chest pain, anxiety (refuses to take again) penicillin > hives
Allergies & Intolerancessulfa > as a child
Imitrex SC > chest pain, anxiety (refuses to take again)
penicillin > hives
Allergies & Intolerances•sulfa > as a child•Imitrex SC > chest pain, anxiety (refuses to take again) •penicillin > hives
Algorithm formatting question ...