82 - Seeking Care, Diagnosis, and Acute Prescription for Migraine Among Those with Headache-Related Disability: Results of the OVERCOME Study
Susan Hutchinson1, Robert Nicholson2, Bert Vargas2, Karen Saaman2, Anthony Zagar2, Yongin Kim2, Eric Pearlman2, Dawn Buse3, Michael Reed4, Sait Ashina5,6, Richard Lipton3,7
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.