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

Sait Ashina, MD

AHSAM 2020 - Oral session
Published on October 2, 2020 | NEW

4 minute listen
9 minute read

Key messages

  • There are three conditional steps to effective preventative migraine treatment: consulting a healthcare professional, receiving an accurate diagnosis and taking a recommended preventative medication.1,2
  • Only 15.4% with disabling migraine traversed these steps.
  • A higher likelihood of traversing the steps was associated with older age, having health insurance, higher migraine frequency, more severe migraine-related disability, pain severity, cutaneous allodynia, poor acute treatment optimization and care sought at a specialist.
  • A lower likelihood of traversing the steps was associated with seeking care at an Emergency Department, Urgent Care or Retail Clinic.
  • Background

    What do we already know about this topic?
  • Findings

    What does this study add?
  • Perspectives

    How does this study impact clinical practice?
  • Expert commentary

    by Thomas N. Ward, MD

Key messages

  • There are three conditional steps to effective preventative migraine treatment: consulting a healthcare professional, receiving an accurate diagnosis and taking a recommended preventative medication.1,2
  • Only 15.4% with disabling migraine traversed these steps.
  • A higher likelihood of traversing the steps was associated with older age, having health insurance, higher migraine frequency, more severe migraine-related disability, pain severity, cutaneous allodynia, poor acute treatment optimization and care sought at a specialist.
  • A lower likelihood of traversing the steps was associated with seeking care at an Emergency Department, Urgent Care or Retail Clinic.

Background

What do we already know about this topic?

  • Understanding the patient’s path to taking recommended preventative migraine medication may help identify barriers to effective treatment.
  • Previous studies have not considered episodic and chronic migraine together and took place in a historical healthcare environment.3,4
  • The observational survey of the epidemiology, treatment and care of migraine (OVERCOME) was a web-based survey providing a contemporary view of the migraine healthcare landscape, considering both episodic and chronic migraine.

How was this study conducted?

  • Subgroup analysis of adult patients from the OVERCOME study with moderate or severe migraine-associated disability (n=5,873), validated by AMS/AMPP diagnostic screener or self-report healthcare provider (HCP) diagnosis.5
  • Subgroups were based upon whether patients sought care over the past 12 months, migraine diagnosis by a HCP, and taking recommended preventative treatment, with data stratified by monthly headache days category: 4–7, 8–14, ≥15 days.
  • Considered measurements of migraine disability, cutaneous allodynia, symptom severity, treatment optimization, quality of life related to migraine, and pain severity. 6,7,8,9

Findings

What does this study add?

  • 69% sought care, and of those 80% were diagnosed and 28.3% subsequently received recommended preventative treatment.
  • Only 15.4% of individuals with ≥4 monthly headache days and moderate or severe headache-related disability, followed the pathway: sought care, diagnosed and take recommended preventative treatment.
  • Seeking care was associated with older age males, having health insurance and severe headache disability, while migraine diagnosis was associated with being female and having severe headache disability.
  • Receiving recommended preventative medication was associated with having health insurance and severe headache disability.
  • Notably, seeking care exclusively at an Emergency Department/Urgent Care/Retail Clinic was associated with lack of diagnosis and not receiving recommended preventative treatments.

Perspectives

How does this study impact clinical practice?

  • There are a large number of barriers but opportunities are available to improve the diagnosis and management of disabling migraine given the current availability of preventative therapies.
  • Patients seeking care exclusively at Emergency Departments, Urgent Care and Retail Clinics need to be referred to a HCP to receive a full diagnosis and effective preventative treatments.

Perspectives

How does this study impact clinical practice?

  • There are a large number of barriers but opportunities are available to improve the diagnosis and management of disabling migraine given the current availability of preventative therapies.
  • Patients seeking care exclusively at Emergency Departments, Urgent Care and Retail Clinics need to be referred to a HCP to receive a full diagnosis and effective preventative treatments.

This is a highlights summary of an oral session given at the AHSAM 2020 Virtual Annual Scientific Meeting and presented by:

Sait Ashina, MD
Assistant Professor of Neurology and Anesthesia
Harvard Medical School, Beth Israel Deaconess Medical Center
Boston, Massachusetts

The content is produced by Infomedica, the official reporting partner of ASHAM 2020 Virtual Annual Scientific Meeting. The summary text was drafted by Goldcrest Medical Writing, reviewed by Marco Vercellino, MD, an independent external expert, and approved by Jessica Ailani, MD, FAHS and Mark J. Burish, MD, PhD, the scientific editors of the program.

The presenting authors of the original session had no part in the creation of this conference highlights summary.

In addition, an expert commentary on the topic has been provided by:

Thomas N. Ward, MD
Geisel School of Medicine at Dartmouth

Thomas N. Ward, MD
Geisel School of Medicine at Dartmouth

Dr. Thomas N. Ward grew up in Portsmouth, NH where he attended the public school system. He graduated from Dartmouth College cum laude in 1975 and from Dartmouth Medical School with honors in 1980 and was elected a member of AOA.

He was an intern and resident in Internal Medicine at Albany Medical Center from 1980-1982 then a resident in Neurology from 1982-1985 at Dartmouth-Hitchcock Medical Center. Subsequently he practiced Neurology at Laconia Clinic in Laconia, NH until returning to Dartmouth-Hitchcock Medical Center in 1989 where he founded their headache clinic.

Dr. Ward is a Fellow of the American Headache Society and of the American Academy of Neurology as well as the American Neurological Association. He is President of the Headache Cooperative of New England and certified in the subspecialty of Headache Medicine by the United Council for Neurologic Subspecialties. He is an Active Emeritus Professor of Neurology at the Geisel School of Medicine at Dartmouth. He was the Editor in Chief of the journal Headache: the journal of head and face pain from 2013-2020. He currently sees patients at the White River Junction, VA Hospital

1. Silberstein SD, Holland S, Freitag F, et al. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology 2012;78:1337-1345

2. American Headache Society. The American Headache Society Position Statement On Integrating New Migraine Treatments Into Clinical Practice. Headache 2019;59:1-18.

3. Dodick DW, Loder EW, Manack Adams A, et al. Assessing Barriers to Chronic Migraine Consultation, Diagnosis, and Treatment: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. Headache 2016;56:821-834. 

4. Lipton RB, Serrano D, Holland S, et al. Barriers to the diagnosis and treatment of migraine: effects of sex, income, and headache features. Headache 2013;53:81-92. 

5. Lipton RB, Stewart WF, Diamond S, et al. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache 2001;41:646-657. 

6. Stewart WF, Lipton RB, Dowson AJ, et al. Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability. Neurology 2001;56(Suppl 1):S20-S28.

7. Lipton RB, Bigal ME, Ashina S, et al. Cutaneous allodynia in the migraine population. Annals of Neurology 2008;63:148-158.

8. Lipton RB, Kolodner K, Bigal ME, et al. Validity and reliability of the Migraine-Treatment Optimization Questionnaire. Cephalalgia 2009;29:751-759.

9. Martin BC, Pathak DS, Sharfman MI, et al. Validity and reliability of the migraine-specific quality of life questionnaire (MSQ Version 2.1). Headache 2000;40:204-215.

 



Headache
Migraine


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