Nearly Half of Patients With Migraine Hesitate to Seek Care


The reported reasons included wanting to take care of symptoms themselves, concern that migraine will not be taken seriously, and believing migraines are not severe or painful enough to seek care.

Robert E. Shapiro, MD, PhD, department, Neurological Sciences, Larner College of Medicine, University of Vermont

Robert E. Shapiro, MD, PhD

Data from the OVERCOME study, a prospective, web-based survey of people in the US with migraine, has revealed that nearly half (45.5%) of respondents have hesitated to consult their physicians for migraine care.1 These findings were presented at the 2021 Virtual American Headache Society (AHS) 63rd Annual Scientific Meeting, June 3-6, by Robert E. Shapiro, MD, PhD, department, Neurological Sciences, Larner College of Medicine, University of Vermont.

Investigators found that hesitating was most strongly associated with the patient reported outcomes (PROs) of lower mean Migraine-Specific Quality-of-Life Questionnaire-Role Function-Restrictive domain (MSQ 2.1 RFR; 48.5 in hesitating patients vs 59.6 in non-hesitating) scores and having at least moderate disability (56.2% hesitating; 35.9% not hesitating; P <.001).

"OVERCOME, the largest population-based study of its kind, provides crucial insights to improve migraine care," said Shapiro in a statement.2 "Given that nearly half of survey respondents hesitated to seek migraine care, we urgently need to understand the bases for these barriers and promote more effective dialogue between healthcare providers and people with migraine to improve their health outcomes."

Investigators, including first author Michael L. Reed, PhD, president and founder, Vedanta Research, conducted the multicohort, cross-sectional and longitudinal study in order to assess the influence of sociodemographic, lifestyle, clinical characteristics, and patient reported outcomes on hesitating to consult for migraine care, as little is currently known about what differentiates who seeks from who will not seek care.

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The survey was completed by 41,925 respondents with migraine that reported having at least 1 headache or migraine attack in the past 12 months. These respondents met migraine criteria based on previous screening in the American Migraine Study or American Migraine Prevalence and Prevention study using International Classification of Headache Disorders (ICHD-3; 94.6%) or self-report of migraine diagnosis by a healthcare provider (60%).

"People with migraine want and need rapid and complete freedom from migraine. It's important they find treatment options that work for them so they can stay on them, rather than be dissatisfied or worse, give up hope and not even seek treatment. These new insights reveal barriers to optimal care ..." said Ilya Yuffa, senior vice president and president, Lilly Bio-Medicines. "We hope to inspire people with migraine and healthcare providers to talk about the impact this debilitating neurologic disease has on daily life. People should expect more, and get more, from their treatments on the path to freedom from debilitating migraine pain."

The analysis population consisted of 39,494 respondents that indicated whether they had ever hesitated to seek care from or talk to a doctor or healthcare provider about their migraine. More than half of respondents (54.5%; n = 21,543) said they had never hesitated, while the aforementioned 45.5% (n = 17,951) said they had hesitated. Of respondents who hesitated, 42% (n = 7,495) did not seek migraine care in the preceding 12 months.

Reasons for not seeking care included wanting to take care of symptoms on their own (45%), concern that their migraine would not be taken seriously (35%), believing their migraine attacks were not serious or painful enough to seek care (29%), financial considerations (29%), and insurance access and reimbursement (21%).

In addition to disability and MSQ 2.1 RFR scores, other important factors in hesitating to seek migraine care were poor acute treatment optimization, with 58.6% of hesitating patients reporting this compared to 42.7% of non-hesitating patients (P <.001). Migraine characteristics such as higher severity of cutaneous allodynia (17.6% of hesitating vs 11.2% of non-hesitating; P <.001) and pain during migraine attack (hesitating mean, 7.3; non-hesitating mean, 6.8; P <.001) were also more reported by hesitating respondents.

Clinical and lifestyle factors such as dizziness/vertigo/balance issues (hesitating, 45.0%; non-hesitating, 35.0%; P <.001), depression/anxiety (hesitating, 36.4%; non-hesitating, 26.3%; P <.001), and current nicotine use (hesitating, 36.6%; non-hesitating, 27.7%; P <.001) were reported more by hesitating respondents. More respondents that hesitated were under the age of 40 (56.7% vs 43.3%; P <.001) and had less health insurance (83.6% vs 88.6%; P <.001) compared to those that did not hesitate.

“We conclude that key measures to increase migraine consulting to improve health outcomes might include making an accurate diagnosis of migraine, taking migraine seriously and reducing stigma, and reducing institutional barriers and costs,” said Shapiro during the study presentation.

1. Reed ML, Nicholson RA, Zagar AJ, et al. Important factors associated with hesitating to consult for migraine care: Results of the OVERCOME (US) study. Presented at 2021 AHS Annual Scientific Meeting; June 3-6. Abstract P12
2. Lilly reveals critical barriers to optimal migraine care and insights from novel clinical and patient-centric real-world evidence, supporting Lilly's preventive and acute treatment portfolio at AHS 2021. News release. June 3, 2021. Accessed June 4, 2021.
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