TY - JOUR
T1 - Barriers to care in episodic and chronic migraine
T2 - Results from the Chronic Migraine Epidemiology and Outcomes Study
AU - Buse, Dawn C.
AU - Armand, Cynthia E.
AU - Charleston, Larry
AU - Reed, Michael L.
AU - Fanning, Kristina M.
AU - Adams, Aubrey Manack
AU - Lipton, Richard B.
N1 - Funding Information:
Dawn C. Buse, PhD, has received grant support and honoraria from AbbVie, Amgen, Avanir, Biohaven, Eli Lilly and Company, and Promius, and for work on the editorial board of . Cynthia E. Armand, MD, has served as an advisory board member and has received honoraria from Biohaven and Impel Regional. Larry Charleston IV, MD, MSc, has served as consultant, advisory board member, or has received honoraria from AbbVie, Alder/Lundbeck, and Biohaven. He has performed medical legal consultation for the Vaccine Injury Compensation Program. He is on the advisory board of BrainWeekend and Ctrl M Health, and serves on the editorial board of . Michael L. Reed, PhD, is Managing Director of Vedanta Research, which has received research funding from AbbVie, Amgen, Dr. Reddy's Laboratories, Eli Lilly, and the National Headache Foundation. Vedanta Research has received funding directly from AbbVie for work on the CaMEO Study. Kristina M. Fanning, PhD, is an employee of Vedanta Research, which has received research funding from AbbVie, Amgen, Dr. Reddy's Laboratories, Eli Lilly, and the National Headache Foundation. Vedanta Research has received funding directly from AbbVie for work on the CaMEO Study. Aubrey Manack Adams, PhD, is an employee of AbbVie, and may hold AbbVie stock. Richard B. Lipton, MD, holds stock options in Biohaven Holdings and CtrlM Health. He serves as consultant, advisory board member, has received honoraria from or research support from: Abbvie, American Academy of Neurology, American Headache Society, Amgen, Biohaven, Biovision, Dr. Reddy's (Promius), electroCore, Eli Lilly, eNeura, Equinox, GlaxoSmithKline, Grifols, Lundbeck (Alder), Merck, Pernix, Pfizer, Teva, Vector, and Vedanta. Current Pain and Headache Reports Headache
Funding Information:
This study was sponsored by Allergan (prior to its acquisition by AbbVie)
Publisher Copyright:
© 2021 American Headache Society
PY - 2021/4
Y1 - 2021/4
N2 - Objective: To assess rates of and factors associated with traversing fundamental barriers to good medical outcomes and pharmacologic care in individuals with episodic migraine (EM) and chronic migraine (CM), including socioeconomic status and race. Background: Barriers to good outcomes in migraine include the lack of appropriate medical consultation, failure to receive an accurate diagnosis, not being offered a regimen with acute and preventive pharmacologic treatments (if indicated), and not avoiding medication overuse. Methods: The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study was a longitudinal Internet-based survey. Respondents who met criteria for migraine consistent with the International Classification of Headache Disorders, 3rd edition, had a Migraine Disability Assessment score ≥ 6, and provided health insurance coverage status were included in this analysis. Successfully traversing each barrier to care and the effects of sociodemographic characteristics were examined. Results: Among 16,789 respondents with migraine, 9184 (54.7%; EM: 7930; CM: 1254) were eligible. Current headache consultation was reported by 27.6% (2187/7930) of EM and 40.8% (512/1254) of CM respondents. Among consulters, 75.7% (1655/2187) with EM and 32.8% (168/512) with CM were accurately diagnosed. Among diagnosed consulters, 59.9% (992/1655) with EM and 54.2% (91/168) with CM reported minimally appropriate acute and preventive pharmacologic treatment. Among diagnosed and treated consulters, in the EM group 31.8% (315/992) and in the CM group 74.7% (68/91) met medication overuse criteria. Only 8.5% (677/7930) of EM and 1.8% (23/1254) of CM respondents traversed all four barriers. Higher income was positively associated with likelihood of traversing each barrier. Blacks and/or African Americans had higher rates of consultation than other racial groups. Blacks and/or African Americans and multiracial people had higher rates of acute medication overuse. Conclusions: Efforts to improve care should focus on increasing consultation and diagnosis rates, improving the delivery of all appropriate guideline-based treatment, and avoidance of medication overuse.
AB - Objective: To assess rates of and factors associated with traversing fundamental barriers to good medical outcomes and pharmacologic care in individuals with episodic migraine (EM) and chronic migraine (CM), including socioeconomic status and race. Background: Barriers to good outcomes in migraine include the lack of appropriate medical consultation, failure to receive an accurate diagnosis, not being offered a regimen with acute and preventive pharmacologic treatments (if indicated), and not avoiding medication overuse. Methods: The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study was a longitudinal Internet-based survey. Respondents who met criteria for migraine consistent with the International Classification of Headache Disorders, 3rd edition, had a Migraine Disability Assessment score ≥ 6, and provided health insurance coverage status were included in this analysis. Successfully traversing each barrier to care and the effects of sociodemographic characteristics were examined. Results: Among 16,789 respondents with migraine, 9184 (54.7%; EM: 7930; CM: 1254) were eligible. Current headache consultation was reported by 27.6% (2187/7930) of EM and 40.8% (512/1254) of CM respondents. Among consulters, 75.7% (1655/2187) with EM and 32.8% (168/512) with CM were accurately diagnosed. Among diagnosed consulters, 59.9% (992/1655) with EM and 54.2% (91/168) with CM reported minimally appropriate acute and preventive pharmacologic treatment. Among diagnosed and treated consulters, in the EM group 31.8% (315/992) and in the CM group 74.7% (68/91) met medication overuse criteria. Only 8.5% (677/7930) of EM and 1.8% (23/1254) of CM respondents traversed all four barriers. Higher income was positively associated with likelihood of traversing each barrier. Blacks and/or African Americans had higher rates of consultation than other racial groups. Blacks and/or African Americans and multiracial people had higher rates of acute medication overuse. Conclusions: Efforts to improve care should focus on increasing consultation and diagnosis rates, improving the delivery of all appropriate guideline-based treatment, and avoidance of medication overuse.
KW - consultation
KW - headache
KW - health services accessibility
KW - missing diagnosis
KW - prescription drug overuse
KW - socioeconomic factors
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U2 - 10.1111/head.14103
DO - 10.1111/head.14103
M3 - Article
C2 - 33797078
AN - SCOPUS:85103842075
SN - 0017-8748
VL - 61
SP - 628
EP - 641
JO - Headache
JF - Headache
IS - 4
ER -