Less than one-third of people diagnosed with migraine in the United States takes a recommended acute prescription medication to treat an attack; less than 1 in 5 with frequent migraine headaches takes a preventive medication.
These data, from the initial cohort of the OVERCOME study, were reported Tuesday at the American Headache Society's 2020 Virtual Annual Scientific Meeting.
The OVERCOME (Observational Survey of the Epidemiology, Treatment and Care of Migraine)
A prospective, web-based patient survey designed to follow US population samples with migraine for 2 years following their enrollment. The first population sample of 21 143 began enrollment in 2018. The study also included 10 000 people who did not have migraine, which will allow assessment of how migraine is perceived by those who do not have the disease. The second population sample of 20 782 with migraine was initiated in late 2019.
Using the OVERCOME data, authors assessed the portion of people living with migraine and migraine-related disability (measured with the Migraine Disability Assessment Scale [MIDAS]) who completed 3 critical steps in migraine management:
- Actively sought care with a healthcare professional
- Received a migraine diagnosis
- Took a recommended prescription medication
Researchers were interested in how many respondents completed each step and in migraine-related characteristics such as migraine pain severity and related disability, sociodemographic features, and where respondents sought care for their migraine.
Candidates for acute migraine Rx
- Among OVERCOME respondents with migraine who may benefit from acute prescription medication and experienced at least mild migraine-related disability (MIDAS >6) (n=12 212), 63% sought care; of those, 75% (n=5802) were diagnosed with migraine.
- Among those with diagnosed migraine, just over half (59%;n=3401) took a recommended acute prescription medication.
- Overall, only 28% of the population completed all 3 steps to appropriate care.
Candidates for preventive migraine Rx
- Among study participants who were candidates for a preventive medication (n=5,873), which includes people who experienced 4 or more migraine headache days per month and moderate or severe migraine-related disability (MIDAS >11), 69% sought care (n=4,053) and 79% of those received a migraine diagnosis (n=3,218).
- Of those who sought care and received a diagnosis, only 28% took a preventive medication for migraine (n=902).
- Overall, only 15% of this group of individuals who were candidates for preventive migraine treatment completed all 3 steps to appropriate care.
Stigma, access, education
"Even in light of recent new treatment options in the field of migraine, we still face an uphill battle as too many continue to be underserved," said Robert E. Shapiro, MD, department of neurological sciences, Larner College of Medicine, University of Vermont and scientific advisor to the OVERCOME study in a press release from study sponsor Eli Lilly.
"An important aspect of migraine care that is truly diminished and may contribute to these findings is the stigma felt by many living with the disease. A person's reluctance to seek care or take medication for their migraine can be rooted in the fear of how a friend, employer, or even a loved one may view them for doing so."
For both populations, possessing health insurance and higher levels of migraine-related disability increased the likelihood that respondents would complete all 3 steps.
Another common theme across both populations was approximately 10% of respondents sought care in an emergency room, urgent care, or retail clinic setting only and as a result, were unlikely to receive an accurate diagnosis or take a recommended medication.