Do racial/ethnic disparities exist in recommended migraine treatments in US ambulatory care?

Abstract

Background Racial disparities in migraine have been reported in the US. Migraine in African Americans (AA) is more frequent, more severe, more likely to become chronic and associated with more depression and lower quality of life compared to non-Hispanic Whites (NHW). It is possible that racial differences in prescribing practices contribute to these differences, but little is known about the quality of migraine prescribing patterns in the US or whether racial differences exist. Objective To determine if racial differences in quality of migraine medical prescription care exist. Methods We used data from the National Ambulatory Medical Care Survey to estimate differences in the use of migraine prophylactic and abortive medications by race. Quality of migraine care was defined using the American Academy of Neurology Headache Quality Measure Set (AAN-HQMS). Patients were assigned to one of four categories representing the overall quality of evidence for their abortive and prophylactic medications using the AAN-HQMS. We hypothesized that there would be suboptimal migraine treatment in minority populations. Racial comparisons were made using descriptive statistics after applying NAMCS survey weights. Results Two thousand, eight hundred and sixty visits were included in the study, representing approximately 50 million migraine visits in the US from 2006-2013. In all, 41.3% of AA, 40.8% of NHW, and 41.2% of Hispanic (HI) patients received no prophylactic treatments ( p = 0.99). A total of 18.8% of AA patients, 11.9% of NHW patients, and 6.9% of HI patients received exclusively Level A prophylaxis ( p = 0.30). A total of 47.1% of AA patients, 38.2% of NHW patients, and 36.3% of HI patients received no abortive treatments ( p = 0.23). In total, 15.3% of AA patients, 19.4% of NHW patients, and 17.7% of HI patients received any Level A abortives (i.e. triptans or Dihydroergotamine; DHE, p = 0.64). A total of 15.2% of all patients had a prescription for opiates, but there were no racial differences. Conclusions Migraine may be undertreated with prophylactic medications. Level A acute analgesics may be underused and opiates overused. No major racial/ethnic differences in abortive or prophylactic treatment were identified.

What Will it Take to Move the Needle for Headache Disorders? An Advocacy Perspective

“…Low income is associated with higher migraine attack frequency, 88 and some under‐represented groups have a higher prevalence of both poverty and migraine overall (eg, Native Americans) 87 . Racist perceptions of pain sensitivity may lead to reduced recognition and treatment of pain and migraine 87,89,90 . Stigma toward migraine may deter people from seeking care, and this may be particularly evident among some under‐represented groups 10,11,87 .…”

Equity of African American Men in Headache in the United States: A Perspective From African American Headache Medicine Specialists (Part 1)

“…Nevertheless, racial disparities in headache medicine exist. [8][9][10][11][12][13][14][15] Racial concordance between provider and patient may ameliorate some aspects of care disparities particularly effective provider-patient communication. 16 Given these data and as suggested in the Institute of Medicine report "Unequal Treatment," actions to increase the number of physicians from groups underrepresented in medicine (UIM) are needed.…”

Migraine Care Challenges and Strategies in US Uninsured and Underinsured Adults: A Narrative Review, Part 2

“…Migraine is undertreated with prophylactic medication in the US population as a whole. Of those who receive prophylaxis, prophylactic medications with low quality evidence are prescribed to just over one‐fourth of patients with migraine . In fact, it is almost twice as likely that people with migraine will only receive prophylactic medications with low‐quality evidence as it is that they will receive prophylactic medications with only high‐quality evidence .…”

“…28 In fact, it is almost twice as likely that people with migraine will only receive prophylactic medications with low-quality evidence as it is that they will receive prophylactic medications with only high-quality evidence. 28 We will review the goals of prophylactic or preventive agents in migraine, the considerations for their use, and tips to optimizing preventive therapies in this section of the manuscript. Some natural supplements and complementary agents have high-level evidence as migraine prophylactic agents and they will be discussed in a subsequent section.…”

“…Of those who receive prophylaxis, prophylactic medications with low quality evidence are prescribed to just over one‐fourth of patients with migraine . In fact, it is almost twice as likely that people with migraine will only receive prophylactic medications with low‐quality evidence as it is that they will receive prophylactic medications with only high‐quality evidence . We will review the goals of prophylactic or preventive agents in migraine, the considerations for their use, and tips to optimizing preventive therapies in this section of the manuscript.…”