ACP finds performance measures for migraine headache inadequate to improve patient care
Backs only meaningful, evidence-based performance measures for internal medicine
PHILADELPHIA, April 20, 2026 – The American College of Physicians (ACP) supports meaningful, evidence-based performance measures for internal medicine that improve patient care but does not recommend a core measure for migraine treatment at this time, citing inadequacies in the existing measure. “Core Performance Measures for Migraine Headache: A Review by the American College of Physicians” is published in Annals of Internal Medicine.
Migraine affects roughly 15% of Americans and is the second leading cause of disability among all adults and the leading cause among females aged 15-59. Despite its prevalence and impact, it is often underdiagnosed and undertreated. As part of an initiative to recommend core performance measures for internal medicine physicians, ACP’s Performance Measurement Committee searched for existing U.S. performance measures related to migraine headache, identifying just one. Applying ACP’s measure review criteria, ACP found the measure lacks appropriate testing and key exclusions, relies on outdated guidance, and addresses a minimal performance gap. Further, ACP concluded that the measure adds unnecessary reporting burden for individual physicians. For these reasons, ACP does not recommend adopting a core performance measure for migraine at this time and urges measure developers to continue refining and testing the measure to ensure it becomes reliable, valid, and minimally burdensome for physicians.
ACP also explored potential performance measure concepts derived from the ACP clinical guidelines on preventing episodic migraine and treating acute migraine but decided against proposing a concept because most recommendations were conditional based on low-certainty evidence, making them unsuitable for measurement, or had measure feasibility issues related to documentation, making accurate measurement unrealistic.
“As internal medicine physicians, we’re dedicated to delivering the highest quality care for our patients, and well-designed performance measures are essential tools in achieving that,” said Jan K. Carney, MD, MACP, President of ACP. “ACP believes that everyone deserves high quality health care, yet many existing measures provide little real benefit to patients while creating heavy administrative burdens. Our efforts are best directed toward measures that truly enhance patient care.”
The proliferation of low value measures, and the administrative workload they create, risks worsening primary care workforce shortages and reducing time available for direct patient care. ACP’s core performance measures initiative aims to identify high quality, evidence-based performance measures for internal medicine to be used nationally across all payers and systems to improve care for patients in the U.S.
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About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 172 countries worldwide. ACP membership includes 163,000 internal medicine physicians, related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on X, Facebook, Instagram, Threads, and LinkedIn, and subscribe to our RSS feed.
Contact: Lori Bookbinder, 215-351-2431, lbookbinder@acponline.org