82 - Seeking Care, Diagnosis, and Acute Prescription for Migraine Among Those with Headache-Related Disability: Results of the OVERCOME Study

¹Orange County Migraine and Headache Center, Irvine, USA. ²Eli Lilly and Company, Indianapolis, USA. ³Department of Neurology, Albert Einstein College of Medicine, Bronx, USA. ⁴Vedanta Research, LLC, Chapel Hill, USA. ⁵Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine, and Harvard Medical School, Boston, USA. ⁶Beth Israel Deaconess Medical Center, Boston, USA. ⁷Montefiore Medical Center, Bronx, USA

Purpose
The journey to effective acute prescription treatment for migraine among those with associated disability includes at least three steps: consulting a healthcare professional, receiving an accurate diagnosis and taking a recommended acute prescription. Objectives were: 1) Determine the proportion of people with migraine and associated disability who traverse each of these steps, and 2) Compare individuals at each step on sociodemographic features, migraine-related characteristics, and healthcare utilization for migraine.
Methods
Data were obtained in the fall of 2018 from OVERCOME, a web-based survey conducted in a representative US sample. The study identified persons with migraine based on either ICHD-3 criteria (94% of the sample) assessed with a validated diagnostic screener or self-reported healthcare provider migraine diagnosis (61% of the sample). Those with headache-related disability (MIDAS ≥6) were included. Results are presented by total and categorized by monthly headache day (MHD) groups (0-3, 4-7, 8-14, ≥15). T-test or Chi-square test, for total respondents and stratified by MHD category, evaluated differences between groups at each step (p<0.05).
Results
Of the 21,143 participants with migraine, 12,212 (57.8%) had headache-related disability. The mean age was 40.3 years, 77.1% female, and 70.2% Non-Hispanic white, 7.8% Non-Hispanic black, 11.1% Hispanic, 2.3% Asian, and 8.6% other. Only 63% of the total population sought care and of those, 75.4% were diagnosed with migraine. Among those who sought care and were diagnosed, only 58.6% were taking a recommended acute prescription for migraine (ie, non-opioid acute prescription with level A or B effectiveness per AHS 2015 guidelines). Overall, only 27.9% of the total sample had gone through all these steps. This ranges by MHD group from 22.6% for those with 0-3 MHDs to 35.0% for those with ≥15 MHDs. For care seeking, there were differences for nearly all factors assessed (p<0.001), including having health insurance (Seeking=89.0% vs Not Seeking=80.4%, p<0.001). Overall, 10.6% of those who sought care did so only at an Emergency Department and/or Urgent Care and/or Retail Clinic (a clinic located in a pharmacy or retail store) (ED/UC/Retail). Factors differentiating diagnosis included being female (Diagnosed=76.8% vs Not Diagnosed=70.2%, p <0.001), and having sought care at ED/UC/Retail only (Diagnosed=9.1% vs Not Diagnosed =15.3%, p<0.001). Factors differentiating receiving a recommended acute prescription for migraine included having severe (MIDAS≥21) headache-related disability (Prescribed=55.5% vs Not Prescribed=49.6%, p<0.001), and having sought care at ED/UC/Retail only (Prescribed=5.7% vs Not Prescribed=13.9%, p<0.001). These findings varied across MHD groups.
Conclusions
Only a small proportion of those with headache-related disability traverse all steps to receiving recommended acute prescription for migraine. Having health insurance and more severe disability influenced outcomes. A consistent theme is that seeking care in an Emergency Department/Urgent Care/Retail Clinic only is unlikely to lead to receiving appropriate acute medications. These findings highlight the ongoing unmet needs across MHD groups and care delivery settings.