Discipline-Specific Responses to a Complex Migraine Case: A Vignette-Based Survey Among Neurologists, Psychiatrists, and Family Physicians

Rahşan Karacı^1*Esra Aydin Sunbul²Nil Tekin³Bahar Tasdelen⁴ikbal Humay Arman⁵Füsun Mayda Domaç⁶Aynur Özge⁷

• ¹Department of Neurology, Erenköy Psychiatry and Neurological Diseases Training and Research Hospital, University of Health Sciences,, İstanbul, Türkiye
• ²Departments of Psychiatry Erenköy Psychiatry and Neurological Diseases Training and Research Hospital, University of Health Sciences, istanbul, Türkiye
• ³Department of Family Medicine, Izmir Faculty of Medicine, Tepecik Research and Training Hospital, Health Sciences University,, izmir, Türkiye
• ⁴Department of Biostatistics and Medical Informatics, Medical Faculty, Mersin University,, Mersin, Türkiye
• ⁵Department of Family Medicine, Medipol University,, İstanbul, Türkiye
• ⁶Professor of Neurology, Departments of Neurology, Erenköy Psychiatry and Neurological Diseases Training and Research Hospital, University of Health Sciences,, İstanbul, Türkiye
• ⁷Professor of Neurology, Mersin University Faculty of Medicine, Neurology Department, Mersin, and NOROM Neuroscience and Excellence Center, Ankara,, Mersin, Türkiye

Background:Chronic migraine (CM), especially when complicated by medication overuse headache (MOH), frequently coexists with psychiatric and somatic comorbidities that challenge conventional monodisciplinary management. Integrated, interdisciplinary care has been proposed as a solution, but real-world implementation remains limited.Objective:To evaluate and compare the diagnostic reasoning, treatment preferences, and follow-up strategies among neurologists, psychiatrists, and family physicians when managing a complex case of CM with comorbidities and medication overuse.A case-based, multidisciplinary study was conducted using a structured vignette of a middleaged woman with CM+MOH and multiple comorbidities. Ten questions were asked for each specialty (neurologists, psychiatrists, and family physicians) across Türkiye. Responses from 305 clinicians were analysed via inductive thematic analysis and domain-specific agreement metrics.Neurologists prioritized headache semiology and pharmacological treatment; psychiatrists emphasized psychosocial burdens and behavioral interventions; and family physicians reported heterogeneous decision-making shaped by system-level constraints. Agreement levels varied by discipline and clinical domain. The level of awareness of multimorbidity was high, yet interdisciplinary coordination was limited. Across groups, common barriers included stigma, poor treatment adherence, and unclear referral pathways.Conclusion:CM+MOH patients with multimorbidity constitute a clinically complex population requiring interdisciplinary collaboration. The differences in approach highlight the 4 need for structured care pathways and shared decision-making frameworks. Family physicians can act as pivotal coordinators if supported by headache-specific training and referral networks.