Assessing Barriers to Chronic Migraine Consultation, Diagnosis, and Treatment: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study
Objective To assess the rates and predictors of traversing steps essential to good medical care for chronic migraine, including: (1) medical consultation, (2) accurate diagnosis, and (3) minimal pharmacologic treatment. Candidate predictors included socioeconomic, demographic, and headache‐specific...
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| Published in | Headache Vol. 56; no. 5; pp. 821 - 834 |
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| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Blackwell Publishing Ltd
01.05.2016
Wiley Subscription Services, Inc John Wiley and Sons Inc |
| Subjects | |
| Online Access | Get full text |
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| Summary: | Objective
To assess the rates and predictors of traversing steps essential to good medical care for chronic migraine, including: (1) medical consultation, (2) accurate diagnosis, and (3) minimal pharmacologic treatment. Candidate predictors included socioeconomic, demographic, and headache‐specific variables.
Background
Previous research has established that barriers to effective management for episodic migraine include the absence of health insurance, lack of appropriate medical consultation, failure to receive an accurate diagnosis, and not being offered a regimen with acute and preventive treatments.
Methods/Design
The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, a longitudinal web‐based panel study of migraine, included a cross‐sectional module focused on patterns of and barriers to medical care. Participants eligible for this analysis met the study criteria for chronic migraine, had evidence of headache‐related disability, and provided data on health insurance status. The main outcomes in the current analysis included the proportion of respondents who sought consultation for headache with a designated healthcare professional, self‐reported receiving a diagnosis of chronic or transformed migraine, and received minimal pharmacologic treatment for headache with a focus on prescribed acute and preventive treatments.
Results
In the CaMEO Study, 80,783 respondents provided study data, 16,789 (20.8% of respondents) met criteria for migraine, and 1476 (8.8% of those with migraine) met chronic migraine criteria. In total, 1254 participants (85.0% of those with chronic migraine) met inclusion criteria for this analysis. Of those, 512 respondents (40.8%) reported currently consulting with a healthcare professional for headache. Odds of consulting increased with increasing age (OR 1.02; 95% CI 1.01–1.03), body mass index (BMI) (OR 1.01; 95% CI 1.00–1.03), migraine‐related disability (OR 1.02; 95% CI 1.00–1.04), and migraine severity (OR 1.16; 95% CI 1.11–1.22) and presence of health insurance (OR 4.61; 95% CI 3.05–6.96). Among those consulting a healthcare professional, 126 (24.6%) received an accurate diagnosis and 56 of those with a correct diagnosis (44.4%) received both acute and preventive pharmacologic treatments; odds of a CM diagnosis were higher for women (OR 1.93; 95% CI 1.03–3.61), those with greater migraine severity (OR 1.25; 95% CI 1.14–1.37), and those currently consulting a specialist (OR 2.38; 95% CI 1.54–3.69). No predictors of receiving appropriate treatment were identified among those currently consulting. Among our sample of people with chronic migraine, only 56 (4.5%) individuals successfully traversed the series of 3 barriers to successful chronic migraine care (ie, consulted a healthcare professional for migraine, received an accurate diagnosis, and were prescribed minimal acute and preventive pharmacologic treatments).
Conclusion
Our findings suggest that <5% of persons with chronic migraine traversed 3 barriers to receiving care for headache (consultation, diagnosis, and treatment), representing a large unmet need for improving care in this population. Predictors of consulting a healthcare professional included age, having health insurance, greater migraine‐related disability, and greater migraine symptom severity. Among those consulting, predictors of an appropriate diagnosis included consulting a specialist, female sex, and greater migraine severity. Public health efforts are needed to improve outcomes for patients with chronic migraine by a range of interventions and educational efforts aimed at improving consultation rates, diagnostic accuracy, and adherence to minimal pharmacologic treatment. |
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| Bibliography: | ArticleID:HEAD12774 istex:B239A37A984D07FE5D13827A950D8641EB89595A ark:/67375/WNG-P1NSFJLZ-N Lancet Neurology for services as a medical editor. David W. Dodick, MD, in the past 12 months, has served on advisory boards and has consulted for Allergan, Amgen, Alder, CoLucid, Merck, ENeura, Eli Lilly & Company, Autonomic Technologies, Teva, Tonix, Novartis, Supernus, ScionNeurostim, and Boston Scientific. Within the past 12 months, Dr. Dodick has received royalties, funding for travel, speaking, or editorial activities from the following: Healthlogix, Haymarket Media Group, Ltd., SAGE Publishing, Synergy, Allergan, Lippincott Williams & Wilkins, Oxford University Press, and Cambridge University Press; he serves as Editor‐in‐Chief of (Cambridge University Press, 2010). He receives publishing royalties for Conflicts of Interest Richard B. Lipton, MD, has received grant support from the National Institutes of Health, the National Headache Foundation, and the Migraine Research Fund. He serves as consultant, serves as an advisory board member, or has received honoraria from Alder, Allergan, American Headache Society, Autonomic Technologies, Boston Scientific, Bristol‐Myers Squibb, CoLucid, Eli Lilly, eNeura Therapeutics, Merck, Novartis, Pfizer, and Teva, Inc. He receives royalties from and Dawn C. Buse, PhD, in the past 12 months, has received grant support and honoraria from Allergan, Avanir, and the National Headache Foundation. She is an employee of Montefiore Medical Center, which has received research support funded by Alder, Allergan, Argus, Avanir, CoLucid, Dr. Reddy's Laboratories, Electrocore, Labrys, Merck, and Teva, both directly and via grants to the National Headache Foundation. She is on the editorial board of the Journal of Headache and Pain, Pain Pathways Magazine The British Medical Journal Wolff's Headache Aubrey Manack Adams, PhD, is an Allergan plc employee, and receives stock and stock options. 8th Edition (Oxford University Press, 2009). Elizabeth W. Loder, MD, MPH, receives salary paid to her institution from Michael L. Reed, PhD, and Kristina M. Fanning, PhD, are employees of Vedanta Research, which has received support funded by Allergan plc, CoLucid, Dr. Reddy's Laboratories, Endo Pharmaceuticals, GlaxoSmithKline, Merck & Co., Inc., NuPathe, Novartis, and Ortho‐McNeil, via grants to the National Headache Foundation. and on the editorial boards of , The Neurologist . Pain Medicine News 8th edition (Oxford University Press, 2009), and Handbook of Headache Postgraduate Medicine Cephalalgia ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Dawn C. Buse, PhD, in the past 12 months, has received grant support and honoraria from Allergan, Avanir, and the National Headache Foundation. She is an employee of Montefiore Medical Center, which has received research support funded by Alder, Allergan, Argus, Avanir, CoLucid, Dr. Reddy's Laboratories, Electrocore, Labrys, Merck, and Teva, both directly and via grants to the National Headache Foundation. She is on the editorial board of the Journal of Headache and Pain, Pain Pathways Magazine, and Pain Medicine News. Elizabeth W. Loder, MD, MPH, receives salary paid to her institution from The British Medical Journal for services as a medical editor. Richard B. Lipton, MD, has received grant support from the National Institutes of Health, the National Headache Foundation, and the Migraine Research Fund. He serves as consultant, serves as an advisory board member, or has received honoraria from Alder, Allergan, American Headache Society, Autonomic Technologies, Boston Scientific, Bristol‐Myers Squibb, CoLucid, Eli Lilly, eNeura Therapeutics, Merck, Novartis, Pfizer, and Teva, Inc. He receives royalties from Wolff's Headache, 8th Edition (Oxford University Press, 2009). Conflicts of Interest:David W. Dodick, MD, in the past 12 months, has served on advisory boards and has consulted for Allergan, Amgen, Alder, CoLucid, Merck, ENeura, Eli Lilly & Company, Autonomic Technologies, Teva, Tonix, Novartis, Supernus, ScionNeurostim, and Boston Scientific. Within the past 12 months, Dr. Dodick has received royalties, funding for travel, speaking, or editorial activities from the following: Healthlogix, Haymarket Media Group, Ltd., SAGE Publishing, Synergy, Allergan, Lippincott Williams & Wilkins, Oxford University Press, and Cambridge University Press; he serves as Editor‐in‐Chief of Cephalalgia and on the editorial boards of The Neurologist, Lancet Neurology, and Postgraduate Medicine. He receives publishing royalties for Wolff's Headache, 8th edition (Oxford University Press, 2009), and Handbook of Headache (Cambridge University Press, 2010). |
| ISSN: | 0017-8748 1526-4610 |
| DOI: | 10.1111/head.12774 |