Healthcare resource utilization and direct costs associated with frequent nausea in episodic migraine: Results from the American Migraine Prevalence and Prevention (AMPP) Study

Richard B. Lipton, Dawn C. Buse, Jane Saiers, Daniel Serrano, Michael L. Reed

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: Nausea is a common migraine symptom that is associated with impaired quality-of-life and functional disability. In this study, population-based data were used to elucidate the relationship between nausea frequency and headache-related healthcare utilization and costs in persons with migraine. Research design and methods: Participants with episodic migraine who completed the 2009 American Migraine Prevalence and Prevention (AMPP) Study survey rated their headache-related nausea as occurring never, rarely, <half the time, or ≥half the time with their headaches, and completed questions on symptom frequency and healthcare resource utilization. Main outcome measures: Ordinal logistic regression models were used to assess the association between nausea frequency and headache-related healthcare utilization. Healthcare cost equivalents were calculated. Results: Among the 6488 respondents with episodic migraine, the number of respondents observed across headache-related nausea frequency strata were 6.9% for never, 14.5% for rarely, 29.1% for <half the time, and 49.5% for ≥half the time. In unadjusted models, the odds of having ≥1 healthcare encounter for headache in the preceding year increased with frequency of nausea for primary care/obstetrics-gynecology visits (OR=1.41; 95% CI=1.30-1.52, p<0.001), nurse practitioner/physician assistant visits (OR=1.52; 95% CI=1.25-1.85, p<0.001), neurology/headache clinic visits (OR=1.33, 95% CI=1.18-1.51, p<0.001), pain clinic visits (OR=1.31, 95% CI=1.01-1.71, p<0.05), emergency department visits (OR=1.85; 95% CI=1.56-2.19, p<0.01), and overnight hospital stays (OR=1.50, 92% CI=1.12-2.00, p<0.01). The odds of having ≥1 lifetime CT scan or MRI also increased with the frequency of nausea (p<0.001 for both). Results remained significant in these analyses when controlling for sociodemographics and overall symptom severity except in the case of pain clinic visits (p<0.107). Visits for Mental Health and visits for Chiropractic/Alternative care did not differ significantly by nausea group in unadjusted or adjusted models. Mean estimated direct headache-related healthcare cost equivalents per person per year generally increased with increasing headache-related nausea frequency across categories of healthcare utilization. Average per person healthcare cost for nausea ≥half the time vs nausea never was 179 and 49 yearly for outpatient services, 183 vs 20 yearly for overnight hospital stays, and 314 vs 257 for lifetime diagnostic services/imaging. Conclusions: Direct costs of migraine increase with increasing frequency of migraine-associated nausea. Both frequency and severity of headache-related nausea should be monitored as part of ongoing care of persons with migraine. Headache-related nausea, like headache pain, should be considered an area of central concern during clinical, diagnostic, and treatment optimization assessments. Study limitations: This study relied on self-reported headache frequency and healthcare costs which are subject to recall bias and under-reporting; however, reporting bias is unlikely to be different as a function of nausea frequency. In addition, medication use costs and indirect costs (which may be higher than direct costs for migraine) were not assessed.

Original languageEnglish (US)
Pages (from-to)490-499
Number of pages10
JournalJournal of Medical Economics
Issue number4
StatePublished - 2013


  • Cost
  • Headache
  • Migraine
  • Nausea

ASJC Scopus subject areas

  • Health Policy


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