Ann Intern Med
ACP says migraine performance measure isn’t ready for prime time
Clinical Takeaway: Focus on evidence-based migraine diagnosis and treatment rather than reporting against an inadequately tested performance measure.
Migraine affects about 15% of U.S. adults and is the second leading cause of disability worldwide, yet poorly designed quality measures risk adding paperwork without improving outcomes.
In a review published in Annals of Internal Medicine, the American College of Physicians (ACP) concluded that the only existing U.S. performance measure for migraine headache care falls short of standards needed to improve patient outcomes and should not be adopted as a core measure.
Migraine affects an estimated 39 million Americans and is the leading cause of disability for females ages 15 to 59. Despite this burden, ACP’s Performance Measurement Committee found just one relevant performance measure during a systematic search. When evaluated against ACP criteria, the measure showed major gaps: limited or absent testing, lack of key patient exclusions, reliance on outdated guidance, and only a small performance gap between clinicians.
The committee also determined that the measure would increase reporting burden for individual physicians without clear clinical benefit—a concern amid rising administrative demands and primary care workforce shortages. “Measures should be reliable, valid, and minimally burdensome for physicians,” ACP noted, arguing the current migraine measure does not meet that bar.
ACP additionally explored whether its own clinical guidelines could support new migraine quality measures. However, most recommendations were conditional, based on low-certainty evidence, or faced feasibility challenges due to documentation limitations, making accurate measurement unrealistic at present.
Authors urge measure developers to refine and rigorously test migraine-related measures before widespread use. Until then, ACP recommends prioritizing high-value, evidence-based care over formal performance reporting for migraine management.
Source: Qaseem A, et al. (2026, April 21). Ann Intern Med. Core Performance Measures for Migraine Headache: A Review by the American College of Physicians