番茄社区

Fewer than one in three people with migraine took guideline-recommended prescription medication, data presented at the (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 番茄社区.

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 diagnostic screener using (94% of sample).

In the entire study population, 12,212 people had at least mild migraine-related disability (a 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 and the 2018 AHS 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 . 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.