Awareness of Chronic Migraine Diagnosis and Management among Primary Care Physicians in PSMMC in Riyadh

Abstract

Background: Chronic migraine (CM) is a disabling neurological disorder frequently underdiagnosed and undertreated in primary care, despite its high prevalence and burden on patients and healthcare systems. Primary care physicians (PCPs) are the frontline providers for headache management, and their knowledge and attitudes directly impact early recognition and evidence-based treatment. Limited regional studies have suggested significant gaps in PCPs’ knowledge of CM in Saudi Arabia. Objective: This study aimed to assess the level of awareness, diagnostic accuracy, and management knowledge of chronic migraine among PCPs at Prince Sultan Military Medical City (PSMMC), Riyadh, and to identify factors associated with higher knowledge scores. Methods: A cross-sectional survey was conducted among PCPs in PSMMC from June to July 2025. A validated, self-administered questionnaire comprising 20 knowledge items (scored correct/incorrect) and two attitude questions was distributed electronically. Knowledge scores (0–20) were categorized using modified Bloom’s cut-offs: high (16–20), moderate (12–15), and low (0–11). Data were analyzed with descriptive statistics, score results, chi-square tests, and KR-20 for reliability. Results: A total of 145 physicians completed the survey. Overall reliability of the knowledge scale was strong (KR-20 = 0.84). The mean total knowledge score was 17.4 ± 3.3, with 77.9% classified as high knowledge, 13.8% as moderate, and 8.3% as low. Diagnostic criteria, red flag recognition, and acute management were well known, but gaps persisted regarding attack duration, follow-up intervals, and non-pharmacological therapies. Significant associations with knowledge levels were observed for age (p = 0.019), nationality (p < 0.001), grade (p = 0.032), years of experience (p = 0.008), and prior course attendance (p = 0.007). Most participants felt very confident in diagnosing CM (64.8%), but fewer expressed confidence in managing it (43.4%). Conclusion: PCPs at PSMMC demonstrated generally high knowledge and diagnostic confidence in CM, yet important deficiencies remain in preventive strategies and non-pharmacological management. Regular continuing medical education and structured training programs are recommended to address these gaps and optimize migraine care in Saudi primary care settings.