Annals of Internal MedicineCore Performance Measures for Migraine Headache: A Review by the American College of Physicians

🎓 Expert Commentary / Peer Perspective

The ACP Performance Measurement Committee declined to support MIPS Quality ID #419 (“Overuse of Imaging for the Evaluation of Primary Headache”) and did not recommend a core performance measure for migraine treatment, citing outdated guideline basis, incomplete exclusions, and data feasibility barriers.

Professional Impact

• ACP cited lack of physician- and group-level testing for MIPS #419, alongside a 2025 benchmark average below 1%, indicating minimal performance gap.
• Exclusion list is missing key populations including immunocompromised patients and those with cancer, and depends on burdensome G-code reporting rather than standard ICD-10 or SNOMED-CT codes.
• A measure concept around adding a triptan to NSAID for moderate-to-severe acute migraine was considered but rejected on feasibility grounds, as OTC NSAID use cannot be reliably documented.
• Migraine affects roughly 15% of the US population and remains the top cause of disability in women aged 15 to 49, underscoring the gap between disease burden and accountable measurement infrastructure.

Action Items

• Review current MIPS #419 reporting workflow and document the measure’s limitations for internal quality discussions.
• Document OTC medication use consistently in EHR medication lists to support future measure feasibility.
• Advocate through professional channels for code sets capturing OTC medication use and treatment adequacy.
• Evaluate local quality improvement projects using patient-reported outcome measures rather than accountability-grade metrics.