ACP Performance Measurement Committee Weighs In on Measure for Migraine Headache

The committee found the existing measure to be ineffective, but did not find sufficient strong evidence to recommend an alternative measure for this condition

April 24, 2026 (ACP) -- The American College of Physicians does not support the only quality measure for migraine care, finding it unnecessary and untested.

“Migraines can be debilitating for a large population of people, and this would be an ideal type of condition for a performance measure. We just don't have one that works,” said Dr. Rebecca Andrews, immediate-past chair of the ACP Board of Regents, immediate-past chair of the ACP Performance Measurement Committee and coauthor of the ACP review of the measure in Annals of Internal Medicine.

The Centers for Medicare and Medicaid Services, insurers and health systems use performance measures to evaluate physician quality, and ACP believes they must be valid. “If there's no gap in care, it doesn't make sense to have a performance measure,” Andrews explained. “If the data isn't good, and if the measure hasn't ever been tested, then we don't have the buy-in of the medical community to say, ‘You should do this,’ because there's no evidence that it will make a difference.”

The ACP core performance measure initiative aims to identify essential high-quality and evidence-based performance measures for internal medicine across all payers and systems. The ACP Performance Measurement Committee reviews existing measures against criteria including importance, clinical evidence base, measure specifications and feasibility. If no valid performance measure exists, the committee tries to recommend an alternative based on ACP guidelines, if possible.

Migraine is an important condition because it affects an estimated 15 percent of people in the United States, Andrews said. Data have shown it is the second leading cause of disability among all adults and the leading cause among women and girls aged 15 to 59 years. Still, it is often underdiagnosed and undertreated.

The measure related to migraine -- the MIPS Quality ID #419, “Overuse of Imaging for the Evaluation of Primary Headache” -- tracks how many patients are undergoing computed tomography or magnetic resonance imaging scans despite not clinically needing them.

As the ACP review notes, the measure was not tested at the individual physician or group practice level and is based on outdated guidelines. Key groups are not excluded, such as patients who are immunocompromised and those with cancer, who could benefit from imaging. Additionally, “there is little to no room for improvement” since 2025 MIPS benchmark data showed that fewer than 1 percent of patients undergo inappropriate imaging.

The ACP committee discussed ACP's migraine treatment recommendations in search of something they could recommend as a better performance measure.

“Unfortunately, we struggled because there were a lot of conditional recommendations with low-certainty evidence,” Andrews said. Ultimately, the committee did not make an alternative recommendation.

“We should find a performance measure that can really impact migraine care, and right now, we don't have one,” she said. But, according to Andrews, there is hope that a better migraine performance measure will be developed, perhaps one that can use technology to take factors into account such as the use of anti-inflammatory over-the-counter medications.

More Information

The review paper “Core Performance Measures for Migraine Headache” is available on the Annals of Internal Medicine website.

Back to the April 24, 2026 issue of ACP Advocate