Receiving Medical Care for Chronic Migraines

A Phenomenological Study

Douglas McPhee, MS, LMFT-Associate; Cameron C. Brown, PhD, LMFT-Associate; W. David Robinson, PhD, LMFT; Kimberly Jarzynka, MD


South Med J. 2022;115(4):270-275. 

In This Article

Abstract and Introduction


Objectives: Treating chronic migraine (CM) effectively is one of the greatest challenges a primary care provider (PCP) may encounter. Many patients with CM report dissatisfaction and minimal gains from treatment, despite using the best medical interventions available. For this study, patients with CM and their partners provided insight into how PCPs could improve CM treatment.

Methods: Using the immersion/crystallization phenomenological method, we collected data from 11 patients with CM and 8 of their partners (N = 19). We analyzed open-ended survey responses about migraine treatment from patients with CM, as well as transcripts from interviews with patients with CM and their partners (14 interviews total) about their medical experiences.

Results: Participants used a variety of pharmacological and alternative treatments in search of a cure; wanted to be treated more collaboratively; and repeatedly gave up on medical care, but then sought treatment again.

Conclusions: PCPs could be trained to encourage patients with CM to shift toward accepting and managing migraines rather than endlessly hoping for a cure. Patients could be taught to manage CM using a holistic, biopsychosocial approach.


Migraine is the third most prevalent disorder in the world, with approximately 15% of adults in the United States experiencing a migraine within the last 3 months[1,2] and a global prevalence of approximately 0.9% to 5.1%/year.[3] For those who experience chronic migraine (CM), they must deal with headaches at least 15 days per month for 3 months with migraines on at least 8 of those days each month.[4] This frequency and intensity can be intrusive in a patient's employment, relationships, and overall well-being, as illustrated by CM being the third highest cause of disability worldwide for people younger than age 50 years.[1]

Notwithstanding the high prevalence of CM,[1,2] the debilitating effects on a patient's life,[1] and ample medical research exploring treatment and intervention,[5–10] the satisfaction of patients receiving medical care is inconsistent at best. Treating CM effectively is one of the greatest challenges that physicians encounter, with current treatment protocols being widely recognized as deficient.[11,12] Common treatment approaches include pharmacological treatment, acupuncture, physical therapy, massage therapy, and injections.[5,6,10,11] Patients with CM who pursue such interventions frequently experience dissatisfaction, finding treatment gains to be modest at best.[10,12–14] Primary care providers (PCPs) are typically the first providers of treatment for CM, and they tend to coordinate care for patients with CM.[11]

Although it is generally clear that patients with CM are dissatisfied with treatment,[10] extant research exploring patients' perspectives with treatment and how they wish it could be improved is scant.[10] Using a collaborative, community-based approach, we interviewed patients with CM and their partners about their experiences with treatment. We inquired about what recommendations they would make to the medical community to improve treatment quality. Our purpose was not to alter or reinvent well-established treatment guidelines;[11] rather, we sought to complement these recommendations by highlighting areas of potential improvement in patients' lived treatment experiences. Our aim was to provide PCPs with relevant, useful insights that can maximize treatment satisfaction for patients with CM.