By: 18 June 2020
Study highlights need for improvement in migraine care

Less than 30% of people with migraine are taking a recommended prescription medication, highlighting the need for improvement in migraine care, according to an Eli Lilly and Company-sponsored study.

These data are from the initial cohort of the OVERCOME (Observational Survey of the Epidemiology, Treatment and Care of Migraine) study, which collected responses from more than 21,000 people living with migraine.

The OVERCOME study aims to further understand the burden of migraine and stigma experienced by people living with the disease, identify barriers to the appropriate treatment of migraine and assess how the introduction of novel treatment options may influence delivery of migraine care and outcomes. The results were shared during the American Headache Society’s 2020 Virtual Annual Scientific Meeting.

“For millions of people living with migraine, the journey to an appropriate treatment programme is fraught with gaps,” said Dr Susan Hutchinson of Orange County Migraine and Headache Center in California, and scientific adviser to the OVERCOME study.

“There are a variety of reasons at play, but it begins with the fact that many may not realise what they are experiencing is a migraine and not just ‘another bad headache.’ By increasing understanding of this disease, both among the public and with healthcare providers, we can improve the chances a person living with migraine will take the important step of receiving a diagnosis and ultimately, receive appropriate treatment.” 

Using data from OVERCOME, the authors assessed the proportion of people living with migraine and migraine-related disability—as measured by the Migraine Disability Assessment Scale (MIDAS)—who completed three critical steps in migraine management: (i) actively sought care with a healthcare professional, (ii) received a migraine diagnosis, and (ii) took a recommended prescription medication.

The objectives were to assess how many respondents completed each step and to understand migraine-related characteristics such as migraine pain severity and related disability, sociodemographic features and where respondents sought care for their migraine.

Among OVERCOME respondents with migraine who may benefit from acute prescription medication and experienced at least mild migraine-related disability (MIDAS>6) (n=12,212), 63% sought care (n=7,695) and of those, 75% were diagnosed with migraine (n=5,802).

Within the diagnosed population, only 59% took a recommended acute prescription medication (n=3,401). Overall, only 28% of the population completed all three steps to appropriate care.

Among OVERCOME respondents who were candidates for a preventive medication (n=5,873), which includes people who experienced four or more migraine headache days per month and moderate or severe migraine-related disability (MIDAS >11), 69% sought care (n=4,053) and of those, 79% received a migraine diagnosis (n=3,218).

Of those who sought care and received a diagnosis, only 28% took a preventive medication for migraine (n=902). Overall, only 15% of this population completed all three steps to appropriate care.

“Even in light of recent new treatment options in the field of migraine, we still face an uphill battle as too many continue to be underserved,” said Dr Robert Shapiro, of the Department of Neurological Sciences in the Larner College of Medicine at the University of Vermont, and scientific adviser to the OVERCOME study.

“An important aspect of migraine care that is truly diminished and may contribute to these findings is the stigma felt by many living with the disease. A person’s reluctance to seek care or take medication for their migraine can be rooted in the fear of how a friend, employer, or even a loved one may view them for doing so.”

For both populations, possessing health insurance and higher levels of migraine-related disability increased the likelihood that respondents would complete all three steps. Another common theme across both populations was approximately 10 percent of respondents sought care in an emergency room, urgent care or retail clinic setting only and as a result, were unlikely to receive an accurate diagnosis or take a recommended medication.

“The OVERCOME study provides a snapshot into the current state of migraine in America, while reminding us there is much work to be done,” said Dr Eric Pearlman, senior medical director for US neuroscience at Eli Lilly and Company. “We are in a golden era for migraine care with the introduction of new therapeutic options for both the acute and preventive treatment of the disease, but if we don’t address the need for better education, less stigma and improved access to care, we are falling short.”

Source: Eli Lilly and Company