A recent paper supported by several presentations at AAN 2021 elucidate areas of migraine care to improve.
Dawn Buse, PhD
Data from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study suggest that efforts to improve migraine care should focus on improving 4 distinct barriers: increasing consultation and diagnosis rates, improving the delivery of all appropriate guideline-based treatment, and improving avoidance of medication overuse.1
Findings from the longitudinal, internet-based survey were presented at the 2021 American Academy of Neurology (AAN) Annual Meeting, April 17-22. Investigators found that of all reported consultations, 75.7% (n = 1655) of patients with episodic migraine (EM) and 32.8% (n = 168) with chronic migraine (CM) were accurately diagnosed. Among those who received a diagnosis, 59.9% (n = 992) with EM and 54.2% (n = 91) with CM reported minimally appropriate acute and preventive pharmacologic treatment. Among those who were diagnosed and treated, 31.8% (n = 315) in the EM group and 74.7% (n = 681) in the CM group met medication overuse criteria.
“Migraine-associated disability results in absence from work (absenteeism) and lost productivity (LPT) while at work (presenteeism), both of which contribute to substantial economic burden on individuals, employers, and society,” first author Dawn Buse, PhD, clinical professor of neurology, Albert Einstein College of Medicine, said during her presentation.2
The CaMEO study surveyed 9184 people with migraine, 7930 with EM (86.3%) and 1254 with CM (13.6%). Of these respondents, 2187 (27.6%) with EM and 512 (40.8%) with CM reported current headache consultation. The 4 identified barriers to care: health care provider consultation and diagnosis, appropriate treatment, and medication overuse, were only successfully traversed by 677 (8.5%) of EM and 23 (1.8%) of CM respondents. A smaller proportion of respondents with CM traversed all 4 barriers (n = 23; 1.8%) than those with EM (n = 677; 8.5%).
First consultation was achieved by 2699 (29.4%) of respondents overall. Among these respondents, 1823 (67.5%) overcame the second barrier of an accurate diagnosis. Among respondents diagnosed, 1246 (68.3%) received the minimally appropriate acute pharmacologic treatment. Finally, among treated respondents, 383 (35.4%) reported medication overuse.
Buse and colleagues also investigated sociodemographic factors that may influence the ability to overcome the 4 barriers. They found that Black respondents had higher consultation rates than other ethnic groups (P = .025) and that consultation rates significantly increased with household income (P <.001). Presence of health insurance was also significantly associated with consultation (P <.001).
Women were more likely than men to be diagnosed with migraine (P <.001), diagnosis rates increased with household income (P = .014), and diagnosis rates were higher in those with health insurance (P <.001). Among diagnosed respondents, higher income (P <.001) and health insurance (P = .001) were associated with the use of minimally appropriate pharmacotherapy.
In those who received treatment, men were more likely than women to have medication overuse (P = .039) and multiracial and Black respondents had higher rates of medication overuse than other ethnicities (P = .007). Respondents in lower-income households were also more likely to have medication overuse than those with higher income (P = .018) and there was a nonsignificant trend toward Latinx respondents having higher rates than non-Latinx (P = 054).
Buse presented findings of an additional analysis that found that a greater number of positive Migraine Treatment Optimization Questionnaire-5 (M-TOQ-5) responses was associated with lower mean 3-month LPT, absenteeism, and presenteeism days. Mean 3-month LPT ranged from 12.5 days in the poorly optimized (M-TOQ-5 ≤ 1) subgroup to 4.4 days in the well-optimized (mTOQ-5 score 5) subgroup. Mean LPT was significantly associated (P <.01) with treatment optimization in all number of monthly headache day (MHD) groups except for the group with 8-14 MHDs. Treatment optimization was also associated with 3-month absenteeism and presenteeism across MHD groups.
"In people with migraine, better optimized acute treatment is associated with less LPT,“ Buse said. “Optimizing acute treatment may lead to a reduction in indirect costs.”