Fewer than one in three people with migraine took guideline-recommended prescription medication, data presented at the
American Headache Society (AHS) annual scientific meeting showed.
About 28% of survey respondents with mild to severe migraine-related
disability took acute migraine medication, according to online survey
results in the OVERCOME study.
And only 15% of people who had 4 or more monthly migraine days and
moderate to severe migraine-related disability received preventive
treatment, reported Sait Ashina, MD, of Beth Israel Deaconess Medical
Center in Boston, and Susan Hutchinson, MD, of Orange County Migraine
and Headache Center in Irvine, California.
The findings are not surprising, said Stewart Tepper, MD, of the
Geisel School of Medicine at Dartmouth in Hanover, New Hampshire, who
wasn’t involved with the study.
Even among people who had the most severe migraine-related disability, two-thirds didn’t get treatment, Tepper pointed out.
Part of the problem may be education, he noted. “We have been trying
since the 1990s to educate providers about how to diagnose migraine,”
Tepper told
MedPage Today.
But battles with payers also play a role. “It’s very discouraging,”
he said. “Providers have to jump through hoops and, even then, a lot of
drugs are not covered.”
OVERCOME looked at a nationally representative sample of 21,143
people with episodic and chronic migraine who completed a web-based
survey in the fall of 2018. While earlier studies of treatment barriers
were conducted in healthcare environments, “OVERCOME gives a different
view, a contemporary view of the migraine healthcare landscape,” Ashina
said.
Respondents self-reported their migraine diagnosis by a healthcare professional (61% of sample) or fulfilled criteria on the
American Migraine Study diagnostic screener using
ICHD-3 (94% of sample).
In the entire study population, 12,212 people had at least mild migraine-related disability (a
MIDAS
score of 6 or higher) and were included in the acute migraine analysis.
A total of 5,873 people reported moderate or severe migraine disability
(a MIDAS score of 11 or higher) and 4 or more monthly headache days on
average in the past 90 days and were included in the preventive
analysis.
The questionnaire asked about three steps involved in migraine
management: seeking care, receiving a diagnosis, and taking recommended
medication. The study defined recommended medications as those with
established or probable efficacy according to the 2012 American Academy
of Neurology (AAN)/AHS
guidelines and the 2018 AHS
position statement on new migraine treatments.
In the acute migraine analysis, 63.0% sought care, 47.5% were
diagnosed, and 27.9% received treatment. The percentage of people who
received acute treatment ranged from 22.6% of patients with 0-3 monthly
headache days to 35% of those with 15 monthly headache days or more.
In the preventive analysis, 69.0% sought care, 54.8% were diagnosed,
and 15.4% took preventive drugs. The percentage who took preventive
drugs ranged from 11.7% of patients who experienced 4-7 monthly headache
days to 20.3% of those who had 15 monthly headache days or more.
Having health insurance and a high level of migraine-related
disability increased the likelihood of seeking care, getting diagnosed,
and taking treatment. In both groups, about 10% of respondents sought
care in an emergency department, urgent care, or retail clinic only,
making it unlikely that these patients would get an accurate diagnosis
and recommended treatment, Ashina said.
OVERCOME is a prospective, web-based patient survey designed to
follow U.S. population samples with migraine for 2 years, sponsor
Eli Lilly said.
The first population sample of 21,143 migraine patients began
enrollment in 2018; the second sample of 20,782 patients was initiated
in late 2019. In parallel, OVERCOME included 10,000 people without
migraine to identify how migraine is perceived by people who don’t have
the disease.
Disclosures
OVERCOME was sponsored by Eli Lilly.
Ashina reported consulting fees from Allergan, Amgen, Biohaven, Eli
Lilly, Novartis, Percept, Satsuma, Supernus, and Theranica
Pharmaceuticals.
Hutchinson has served on advisory committees, advisory boards, review
panels, or speaker’s bureaus for Alder, Allergan, Amgen, Avanir,
Biohaven, electroCore, Eli Lilly, Promius, Supernus, Teva, and Theranica
Pharmaceuticals, as well as speaking and teaching for Promius.
Primary Source
American Headache Society
