A Real‐World Analysis of Migraine: A Cross‐Sectional Study of Disease Burden and Treatment Patterns

Ford, Janet H.; Jackson, James; Milligan, Gary; Cotton, S; Ahl, Jonna; Aurora, Sheena K.

doi:10.1111/head.13202

Cited by 98 publications

(162 citation statements)

References 33 publications

(66 reference statements)

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“…Effects of preventive treatments on migraine frequency. There was only a mild effect on headache frequency in the three months following preventive drugs prescription, in accord to previous studies based on indirect evidence (3,16,20). This could suggest that there is a bias between Randomized…”

Section: Discussionsupporting

confidence: 86%

Failure of Preventive Treatments in Migraine: An Observational Retrospective Study in a Tertiary Headache Center

Delussi¹,

Vecchio²,

Quitadamo

et al. 2020

Preprint

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BACKGROUND Despite the criteria of acute migraine treatment and prevention have been well described , there are still unmet needs, for a general underuse and low benefit of preventive treatments. The aim of the present study was to observe retrospectively the short term effect of preventive treatment in a cohort of migraine patients come at a tertiary headache center, using data from an electronic medical record. METHODS This was an observational retrospective cohort study on data collected in a tertiary headache center. Data were extracted from an electronic dataset collected between January 2009 to December 2019. Main selection criteria were age 18-75, diagnosis of migraine without aura(MO), with aura (MA) and chronic migraine (CM), a control visit after three months from the first access, prescription of preventive treatment with level of evidence 1 as reported by Italian guidelines. As primary outcome measure we considered the change of frequency of headache at follow up , as second outcomes disability scores , intensity of headache, allodynia; as predictive factors age, migraine duration, sex and headache frequency, allodynia, anxiety and depression at baseline; comorbidity with fibromyalgia. RESULTS Among 6430 patients screened,2800 met the selection, 1800 returned to follow up, 550 withdrawn for adverse events, 1100 were introduced into analysis. One hundred thirty four had a frequency reduction of 50% or more. Flunarizine was used in less severe migraine, with a better effect as compared to other drugs (odds ratio 1.48; p 0.022). Low headache frequency and absent or mild allodynia predicted a better outcome. CONCLUSIONSThe mild effect of preventive drugs on migraine features and the number of patients lost to follow up or dropped out for adverse events confirm that in severely and chronic sufferers the first line preventive approach could delay a more focused therapeutic approach.

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Section: Discussionsupporting

confidence: 86%

Failure of Preventive Treatments in Migraine: An Observational Retrospective Study in a Tertiary Headache Center

Delussi¹,

Vecchio²,

Quitadamo

et al. 2020

Preprint

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“…For patients with migraine, one of the most instrumental factors for evaluating the need for clinical interventions is the number of migraine headache days per month 3,39,40 . Typical recommendations take into account both attack frequency and related disability for informing the initiation of a PMM treatment 3,41 .…”

Section: Discussionmentioning

confidence: 99%

Predicting initiation of preventive migraine medications: exploratory study in a large U.S. medical claims database

Ford

Schroeder

Buse

et al. 2019

Current Medical Research and Opinion

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Objective: Despite guidelines that identify potential patients eligible for preventive migraine medications, their underutilization leaves patients at risk of acute medication overuse, disease progression, and higher healthcare resource utilization and disability. This exploratory, retrospective, observational study aimed to identify which factors predict preventive migraine medication initiation. Demographics and initiation of acute medication use were hypothesized to be predictive of initiation of preventive migraine medication. Methods: The Truven Health Analytics MarketScan 1 U.S. Commercial and Medicare Supplemental claims database (2011-2013) was used to identify adults newly diagnosed with migraine. Patients were divided into 2 subgroups: initiated a preventive migraine medication (antidepressants, anti-epileptics, beta-blockers, or neurotoxins) within 1 year of migraine diagnosis and did not initiate a preventive migraine medication. Logistic regression models were constructed to identify factors associated with preventive migraine medication initiation. Results: Study population included 147,923 patients: 43,660 preventive migraine medication initiators and 104,263 non-preventive migraine medication patients. Best-fit model for predicting preventive migraine medication initiation included: female gender (odds ratio ¼ 1.181 [95% CI ¼ 1.144,1.218]; measured at date of first migraine diagnosis); headache diagnosis prior to migraine diagnosis (odds ratio ¼ 1.538 [95% CI ¼ 1.498,1.579]; measured 1-year before first migraine diagnosis); and sleep disorder (odds ratio ¼ 1.206 [95% CI ¼ 1.161,1.252]), headache/migraine-specific Emergency Department (ED) visit (odds ratio ¼ 1.224 [95% CI ¼ 1.168,1.283]), neurologist visit (odds ratio ¼ 1.502 [95% CI ¼ 1.459,1.547]), and acute medication refills with <90-day gap (odds ratio ¼ 1.509 [95% CI ¼ 1.470,1.549]) each measured at 1-year before first preventive migraine medication. Conclusions: In addition to consistent acute medication refills, specific comorbidity diagnoses, headache/migraine-specific ED utilization, and neurologist care are predictive of preventive migraine medication initiation in the 1-year post-incident migraine diagnosis.

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“…The burden associated with migraine is underestimated even in developed countries despite its high prevalence and severity [ 12 ]. Although the prevalence of migraine in individuals suffering from ≥4 monthly headache days (MHDs) is lower when compared to <3MHDs [ 13 ], the burden is higher [ 14 ]. Studies based on sociodemographic [ 15 ] and general health characteristics of migraine [ 16 , 17 ], HRQoL [ 18 , 19 ], work productivity loss and activity impairment (WPAI) [ 17 ], and healthcare resource utilization (HRU) [ 17 ] have been conducted before.…”

Section: Introductionmentioning

confidence: 99%

Patients’ perspective on the burden of migraine in Europe: a cross-sectional analysis of survey data in France, Germany, Italy, Spain, and the United Kingdom

et al. 2018

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BackgroundMigraine is a distinct neurological disease that imposes a significant burden on patients, society, and the healthcare system. This study aimed to characterize the incremental burden of migraine in individuals who suffer from ≥4 monthly headache days (MHDs) by examining health-related quality of life (HRQoL), impairments to work productivity and daily activities, and healthcare resource utilization (HRU) in the EU5 (France, Germany, Italy, Spain, United Kingdom).MethodsThis retrospective cross-sectional study used data from the 2016 National Health and Wellness Survey (NHWS; N = 80,600). Short-Form 36-Item Health Survey, version 2 (SF-36v2) physical and mental component summary scores (PCS and MCS), Short-form-6D (SF-6D), and EuroQoL (EQ-5D), impairments to work productivity and daily activities (Work Productivity and Activity Impairment Questionnaire (WPAI), and HRU were compared between migraine respondents suffering from ≥4 MHDs (n = 218) and non-migraine controls (n = 218) by propensity score matching using sociodemographic characteristics. Chi-square, T-tests, and Mann-Whitney tests were performed to determine significant differences between the groups after propensity score matching.ResultsHRQoL was lower in migraine individuals suffering from ≥4 MHDs compared with non-migraine controls, with reduced SF-36v2 PCS (46.00 vs 50.51) and MCS (37.69 vs 44.82), SF-6D health state utility score (0.62 vs 0.71), and EQ-5D score (0.68 vs 0.81) (for all, p < 0.001). Respondents with migraine suffering from ≥4 MHDs also reported higher levels of absenteeism from work (14.43% vs 9.46%; p = 0.001), presenteeism (35.52% vs 20.97%), overall work impairment (38.70% vs 23.27%), and activity impairment (44.17% vs 27.75%) than non-migraine controls (for all, p < 0.001). Additionally, HRU was significantly higher for individuals with ≥4 MHDs compared to their matched controls. Consistently, migraine subgroups (4–7 MHDs, 8–14 MHDs and CM) had lower HRQoL, greater overall work and activity impairment, and higher HRU compared to non-migraine controls.ConclusionsMigraine of ≥4 MHDs was associated with poorer HRQoL, greater work productivity loss, and higher HRU compared with non-migraine controls. The findings of the study suggest that an unmet need exists among individuals suffering from ≥4 MHDs in the EU5 suggesting the need for effective prophylactic treatments to lessen the humanistic and economic burden of migraine.

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A Real‐World Analysis of Migraine: A Cross‐Sectional Study of Disease Burden and Treatment Patterns

Cited by 98 publications

References 33 publications

Failure of Preventive Treatments in Migraine: An Observational Retrospective Study in a Tertiary Headache Center

Failure of Preventive Treatments in Migraine: An Observational Retrospective Study in a Tertiary Headache Center

Predicting initiation of preventive migraine medications: exploratory study in a large U.S. medical claims database

Patients’ perspective on the burden of migraine in Europe: a cross-sectional analysis of survey data in France, Germany, Italy, Spain, and the United Kingdom

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