Migraine management in Chinese headache centers: a national survey and the role of quality control inspections

A systematic quality control (QC) inspection system is very important to standardize migraine management. This study assesses the impact of the QC inspections on center operations, guideline adherence, and patient outcomes for an established national tiered headache care network in china, hoping to identify the key improvements that inform national care optimization strategies. A multi-center cross-sectional study was conducted in China. Lead physicians from 103 headache centers completed a structured electronic questionnaire covering headache consultation capacity, migraine treatment status, comorbidity and disability assessment, and comprehensive management. Centers were stratified by QC inspection status (29 inspected, 74 non-inspected), and outcomes were compared using nonparametric tests. Centers had a median of 4 [IQR: 3-5] headache specialists operating 4 [IQR: 2-6] half-day weekly headache clinics. Migraine accounted for 40% of the caseload, with chronic migraine and conventional acute drugs resistant migraine comprising approximately 40%. The most frequently recommended acute medications were rimegepant, ibuprofen, and acetaminophen; leading preventive medications included flunarizine, topiramate, and CGRP receptor antagonists. Non-pharmacological therapies were recommended by over 50% of specialists, yet patient uptake was less than 10%. QC-inspected centers operated significantly more clinic sessions per week (median 6 [4–8] vs. 3.5 [2–5] half-days, p = 0.0082), had higher rates of headache diary use (30% [20%–50%] vs. 20% [10%–40%], p = 0.0315), and demonstrated better follow-up rates for medication overuse headache (80% [50%–80%] vs. 50% [15%–80%], p = 0.0131) and higher rates of headache control (70% [50%–85%] vs. 60% [40%–80%], p = 0.0496). These centers also prescribed fewer Chinese patent medicines, and used more evidence-based preventive agents (e.g. galcanezumab, amitriptyline, p < 0.05), and conducted more continuing medical education sessions for physicians (median 5 [IQR: 4-10] vs. 3 [IQR: 2-5] per year, p = 0.0044). Headache centers in China generally provide guideline-adherent care for migraine cases, although access to specific therapies remains limited. QC inspections are associated with improved operational capacity, standardized management, and increased use of evidence-based treatments. Enhancing QC inspections, expanding access to advanced therapies, and strengthening physician and patient education are essential to further optimize China’s headache care network.