70 - Identifying Barriers to Care-seeking, Diagnosis, and Preventive Medication Among Those With Migraine: Results of the OVERCOME Study

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

Purpose
Understanding the patient path to receiving evidence-based preventive treatment for migraine may help identify barriers to effective treatment. The objectives were: 1) identify the proportion of those with migraine who are seeking care, have a migraine diagnosis, and are receiving recommended preventive medications and 2) compare individuals at each step regarding sociodemographic features, migraine-related characteristics, and migraine care-seeking location.
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). Candidates for recommended preventive treatment were defined as having ≥4 monthly headache days (MHDs) and at least moderate headache-related disability (MIDAS≥11). Respondents were categorized by MHD group (4-7, 8-14, ≥15). T-test or Chi-square test, across all respondents and stratified by MHD group, evaluated differences between groups at each step (p<0.05).
Results
We identified 5,873 (27.8% of OVERCOME respondents) as candidates for preventive treatment. The mean age was 40.9 years, 79.7% female, and 74.1% Non-Hispanic white, 5.5% Non-Hispanic black, 9.9% Hispanic, 1.6% Asian, and 9.0% other (Table). Only 69% of the total population sought care and of those, 79.4% were diagnosed. Among those who sought care and were diagnosed, only 28.0% received recommended preventive treatment (Figure). Overall, only 15.4% of the total population went through all three steps. This ranged by MHD categories from 11.7% for those with 4-7 MHDs to 20.3% for those with ≥15 MHDs. Seeking care was associated with being male (Seeking=21.8% vs Not Seeking=16.9%, p<0.001), having health insurance (Seeking=89.4% vs Not Seeking=80.1%, p<0.001), and having severe (MIDAS ≥21) headache disability (Seeking=74.2% vs Not Seeking=63.1%, p<0.001). Migraine diagnosis was associated with being female (Diagnosed=79.5% vs Not Diagnosed=73.4%, p<0.001) and having severe headache disability (Diagnosed=75.4% vs Not Diagnosed=69.6%, p<0.001). Being prescribed recommended preventive medication was associated with having health insurance (Prescribed=94.5% vs Not Prescribed=87.7%, p<0.001) and having severe headache disability (Prescribed=80.6% vs Not Prescribed=73.4%, p<0.001). Notably, seeking care exclusively at an ED/Urgent Care/Retail Clinic was associated with lack of diagnosis (Diagnosed=7.8% vs Not Diagnosed=12.9%, p<0.001) and not receiving recommended preventive treatments (Prescribed=2.2% vs Not Prescribed=9.9%, p<0.001).
Conclusions
Less than 1 in every 5 individuals with ≥4 MHDs and at least moderate disability traverse the steps to receiving recommended preventive migraine medication. Having health insurance, and higher levels of disability make this outcome more likely, whereas seeking care only at an ED, Urgent Care, or Retail Clinic makes it unlikely. These findings demonstrate the ongoing high level of barriers and opportunities for improvement in diagnosis and management of migraine given current availability of novel preventive therapies.