For millions of people living with migraine, getting the proper diagnosis can take years, sometimes even decades. A new digital tool developed by a team at the University of Illinois College of Medicine Peoria (UICOMP) and OSF HealthCare aims to change that by helping primary care and other first-contact healthcare providers to identify patients with migraine quickly and accurately.

Hrachya Nersesyan ​MD, PhD, a headache neurologist and the director of the headache clinic at the OSF Illinois Neurological Institute (INI) in Peoria, Illinois and co-developer of the MIGRO (migraine referral optimization) application says primary care providers might frequently experience time constraints to accurately diagnose migraine.

“Well, they have to deal with 55 different problems, all at the same time, and the time constraint is a significant barrier in properly obtaining the history of the headache to be able to correctly and accurately diagnose, not just migraine, but also its sub-types, and decide what to do about that.”

Unlike conditions that can be confirmed with blood tests or imaging, migraine is diagnosed based on presenting symptoms and patient history. That makes accuracy of diagnosis highly dependent on the provider’s time and expertise.

Migraine is one of the most frequent and most disabling types of primary headaches, and what is often misunderstood about migraine is that it is a disorder of the central nervous system. So, it is not just a bad headache but frequently presents with many other symptoms, such as sensitivity to light and sound, nausea and vomiting, disturbances of mood and emotions, and so on. And these disturbances – sometimes called most bothersome symptoms (MBS) – also can happen outside of the actual headache attacks, causing significant discomfort and even prolonged periods of disability to migraine sufferers. Therefore, timely diagnosis and subsequent proper treatment of migraine as a disorder rather than a symptom is important.

In an analysis of randomly selected 150 patients referred to the headache program at OSF ,in 2022, researchers found that primary care providers correctly identified migraine types only about half the time and did not  correctly define the migraine subtypes in most cases due to incomplete information and lack of documentation on the quality and behavioral patterns of reported headaches.

“Some of them, it took five, eight, even 10 years to even being diagnosed and receiving the treatment. We had a couple of patients that mentioned their headaches over 20 years ago and just 20 years later (they) were able to be finally diagnosed with the proper type (of migraine) and be introduced to treatment.”

To address that care gap, the research team created an app called MIGRO, built around a decision-tree algorithm based on the current International Classification of Headache Disorders (ICHD-3). The app guides patients through a series of self-directed questions about their symptoms, headache quality and the patterns of headache behavior. Within minutes, it generates a summary of suspected headache diagnosis for the provider to review.

It simply walks the patient and provider through the key points needed to determine whether a headache is migraine, what type of migraine it might be, or if it’s something else entirely. Most people can complete the assessment in less than five minutes.

Through incorporated safeguards the app also helps to flag potentially dangerous conditions with headache as a symptom that might require immediate attention and reliably diagnoses medication overuse headaches, a significant cause of a headache changing from occasional to chronic.

After early development and more testing at INI with more than 300 patients, the app outperformed referring providers in diagnostic accuracy of the headache type across the board, especially in detecting migraine subtypes and medication overuse headache. In cases of medication overuse headache, the app identified the condition in 65% of patients, compared to 0% recognition by referring clinicians.

Time to validate

Now entering phase two, the team plans to validate the tool in primary care settings across the OSF HealthCare Ministry, including at several rural sites where access to specialists is limited. Dr. Nersesyan explains the app will also help primary care providers in those settings to know if a patient can be managed locally or absolutely needs to be referred to a headache specialist.

“Because a majority of the migraineurs can be managed with very simple medications and interventions as long as they have the right diagnosis and the right treatment and they don’t necessarily need to see a headache neurologist or any other headache specialist.  they can be very well managed by primary care providers.”

This study is supported by a Community Health Advocacy (CHA) grant through OSF and the University of Illinois Chicago. The digital development work is supported by the OSF Digital Innovation Development and Medical Visualization teams, which created the coding and are now refining the app’s language and design for broader public use. The goal is to make the patient questionnaire portion of the application easy to comprehend for every user, regardless of their educational background, and seamlessly integrate this tool into routine clinical workflows.

People with migraine also might frequently hesitate to seek early medical care due to variety of reasons, including social stigma associated with this disorder. The app creators believe that MIGRO can help primary care providers make timely and accurate migraine diagnosis., dramatically shortening the time to implementing an effective treatment. They also believe it could help these patients to overcome societal prejudice about headaches.

“It allows and gives the ability to providers, in a fairly short period of time to hit all the key question marks and points that one needs to come to the diagnosis of migraine or to say, ‘Well this headache is not a migraine,’ or to define between different types of migraine that exists out there.”

The research team expects to begin primary care testing by the end of 2025, with plans to expand the app for general public use once validation of diagnostic accuracy in primary care setting is completed.

Dr. Hrachya Nersesyan 

B-roll of MIGRO app

As we begin a new year at OSF HealthCare, we’re reflecting on 2024 and the major strides in digital transformation to make access to care and health information seamless for our patients. At OSF, we continue to collaborate with our academic and business partners to leverage collective expertise and to responsibly use the power of artificial intelligence, always taking care to use guiding principles of what is fair, appropriate, valid, effective and safe (FAVES).

The efforts are highlighted here in our Top 10 Digital Health and Innovation stories of 2024 in no particular order.

1. OSF Unveils new 55+ primary care service in south suburban Chicago: Called OSF Complete Care 55+, this is a unique collaboration between OSF HealthCare Little Company of Mary Medical Center and OSF OnCall, the digital arm of the health care Ministry. When launched in early 2025, this primary care program will incorporate in-person visits, plus a mix of virtual care, digital health monitoring tools and 24/7 access to a care team focusing on those with chronic conditions.

2. Building an AI prepared workforce: OSF HealthCare leaders took just six weeks to develop mandatory training about generative AI for all 24,000 OSF Mission Partners (employees) because tools were already publicly available. Melissa Knuth, Vice President of Planning, outlines that to rise to the challenge, she worked with OSF Innovation to use mixed media to keep the content interesting and tapped generative AI tools to assist with the content creation.

3. OSF Digital Hospital patients in Rockford area say it’s the best medicine: OSF OnCall expands its digital hospital program to Rockford and receives rave reviews from some of its first patients. In addition, a well-known farm broadcaster shares her story about receiving acute-level care from the comfort of her own home and urges others who are eligible to consider the option.

4. OSF Innovation sets the table for solution to prevent cancelled surgeries: Two OSF HealthCare nurses turned to the OSF Innovation Studio team to help improve their Device Table software that serves as a database for implanted medical devices – offering information needed for surgical teams to reference for safety in surgery planning. We also reported on the creation of a spin-off company, OpenSurg, which will license and promote widespread sales of Device Table and related support features.

5. OSF HealthCare experts: ‘Establish guiding principles when developing digital care strategy’: OSF OnCall was a spotlight vendor and presenter at this year’s American Telemedicine Association’s annual Nexus conference in Phoenix, Arizona. OSF OnCall Senior Vice President Jennifer Junis advised during her presentation that health systems use guiding principles when developing their approach to digital health and to involve clinicians and patients when piloting new programs and digital tools. OSF HealthCare has also become a founding member of an ATA Digital Center of Excellence.

6. Mapping the future for early diagnosis of rare diseases: A Jump ARCHES grant-funded project with the University of Illinois Urbana-Champaign is using generative AI and knowledge graphs that map symptoms to detect rare diseases. Adam Cross, MD, who leads the OSF Children's Innovation Lab in Peoria, Illinois, wants to create a point-of-care tool for primary care providers to help patients get an early diagnosis of a rare disease.

7. Health economist: Connectivity and trust can expand telehealth: OSF OnCall hosted its first-ever digital health symposium which drew nearly 150 clinicians and vendors. Keynote speaker health economist and advisor Jane Sarasohn-Kahn stressed evidence-based digital technologies can improve health outcomes, but health systems need to build trust and expand community partnerships to increase engagements.

8. Fast-Tracking Hope: Rapid Intake at the OSF Cancer Institute: OSF HealthCare began 2024 with the opening of its new comprehensive Cancer Institute, offering advanced radiation therapy such as brachytherapy and proton beam therapy.  It also launched a new rapid intake system, developed by OSF OnCall and OSF Innovation to offer a single point of contact through OSF-HOPE (844- 673-4467) so cancer patients can be immediately connected to treatment and support services.

9. Piloting a smarter colonoscopy: OSF HealthCare St. Joseph Medical Center piloted artificial intelligence-backed colonoscopies, using a company called GI Genius, to improve detection of precancerous polyps. During the pilot, the adenoma detection rate (ADR) averages increased among all patients involved to as high as 12%, while individual physician ADR increased as high as 32.8%. The technology is now being implemented across the OSF Ministry.

10. Testing the path to better concussion diagnosis: An OSF Innovation lab-designed FlightPath app is now being tested by athletes at Illinois State, Bradley and Illinois Wesleyan Universities. The app only takes about two minutes to collect more than a million data points as a person tries to catch a hummingbird within a 3D space on a screen. The clinical trial could last two years.