NEW ORLEANS — Migraine remains undiagnosed and undertreated in as many as 50% of people with the condition, making it essential for primary care clinicians to take a thorough headache history in order to better recognize and treat the condition.

An estimated that 28 million Americans suffer from migraine — approximately 18% of the population — accounting for about $13 billion annually in missed workdays and impaired work function and $9.5 billion in direct medical costs.

“Migraine is a disease that if treated early in progression can usually be halted. It’s important for patients to recognize pattern of headache and report it as soon as possible,” said Theresa Mallick‐Searle, MS, RN‐BC, ANP‐BC, at the American Association of Nurse Practitioners 2015 meeting.

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Mallick-Searle, a pain management specialist of Stanford University Medical Center at the University of California San Francisco, sat down with The Clinical Advisor to discuss the first line group of questions primary clinicians should be asking when assessing a patient with headache symptoms, using the mnemonic OLD CAARTS.

Another area of confusion for many primary care clinicians who are assessing patients with headache is when to use imaging studies. Neuroimaging studies are not recommended for patients with stable headache who meet criteria for migraine, according to American Headache Society recommendations.