Care Among Migraine Patients in a Commercially Insured Population

DOI: https://doi.org/10.1007/s40120- 020- 00179- 3

Abstract-Summary Migraine management is characterized by the poor use of preventive therapy and the overuse of acute medications.

The aim of this study was to describe treatment patterns and healthcare utiliza-

tion of newly diagnosed migraine patients.

This was a retrospective observation study of newly diagnosed migraine patients (no indication of migraine in the past year) identified in the IBM MarketScan Commercial Claims and Encounters database from 1 January 2010 to 30 June 2014. Patients generally used acute and preventive therapies to manage migraine

attacks, with most patients using preventive therapy (59.1%).

Most of the patients who discontinued preventative therapy also used an acute treatment to manage migraine attacks after discontinuation (77.6%), generally in the year following discontinuation (68.4%).

Patients on acute therapies were found to use triptans excessively (1.6%) and

other non-migraine-specific acute medications for treatment (7.1%).

Newly diagnosed migraine patients are not being properly treated, as indicated by their excessive use of acute therapies and short time on preventive treatment before discontinuation of that treatment.

Further study of the reasons why patients discontinue preventive therapy (adverse events, no response, etc) and continue to excessively use acute treatments once their treatment regimen has been established is needed.

Introduction A study of migraine patients in a tertiary headache center reported that those who used both acute and preventive treatment regimens had a marked reduction in the Migraine Disability Assessment Score (MIDAS) after starting treatment, indicating an improvement in their quality of life [456].

The literature highlights poor use of migraine therapy (poor preventive therapy use and overuse of acute therapies) and shows that when properly treated, migraine

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patients have an improved quality of life that includes reduced healthcare costs and HRU.

The aim of this study was to expand the body of information currently available on healthcare utilization by migraine patients and on the treatment received by these patients by evaluating potential quality of care indicators for newly diagnosed migraine patients with a focus on treatment (preventive and acute) and HRU in a commercially insured claims dataset.

Methods All reported outcomes were measured during the variable-length follow-up period, which was defined as the time from the index date until the earliest of IP death, end of continuous enrollment or 30 June 2015 (end of study).

The following measures of acute migraine treatment were described: patients with any use, who also used preventive treatment, had an opioid or barbiturate as first-line acute treatment and showed excessive use of acute treatment.

Additional measures among patients who discontinued preventive treatment included those who used acute medication after discontinuing preventive treatment at any time after discontinuation and within the first year, those who restarted pre- ventive treatment after discontinuing, and time from discontinuation to end of follow-up.

Continuous measures were reported as per patient per month (PPPM) to account

for the variable-length follow-up period.

Results Of those who had a migraine-related office/neurologist visit after a migraine-related ER visit, less than half made an office (36.5%) or neurologist (30.2%) visit within 2 weeks; on average, these visits occurred >100 days after a migraine-related ER visit (office visits 111.0 ± 206.2 days; neurologist visits 132.7 ± 236.9 days).

More than half of the study patients used preventive medication (59.1%) and

started treatment within 0.7 months (median) of their diagnosis.

Patients starting on a second preventive treatment stayed on that treatment for a median of 3.0 months, and 45.0% subsequently started a third preventive treatment. About one-half (48.8%) of patients who discontinued preventive therapy never started another preventive therapy during the median post-discontinuation follow- up time of 26.5 months.

The use of opioids or barbiturates as the first acute migraine therapy was observed

in 34.1% of all acute therapy users and in 29.5% of acute therapy-only users.

Discussion The results of this study describe patterns of healthcare utilization and treatment among newly diagnosed migraine patients in a commercially insured dataset.

The use of acute and preventive treatment was higher in our patient population than reported previously [457], but the patient population in this prior study com- prised of established migraine patients whereas only newly diagnosed migraine patients were enrolled in our study.

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Migraine management requires time, and a higher use of both preventive and acute treatments in newly diagnosed migraine patients within the first years of diag- nosis is expected [458, 459].

Observed utilization differences could be due to differences in migraine severity, differing time periods observed and data used; in addition, newly diagnosed patients may use more healthcare resources than established patients to obtain a treatment regimen [460–462].

The evaluation of a link between utilization and treatment patterns with migraine severity among new migraine patients using survey or medical chart data is a worth- while future study.

Conclusions This analysis of treatment patterns of newly diagnosed migraine patients suggests poor migraine management characterized by inadequate preventive treatment per- sistence, initial treatment with opioids and barbiturates instead of less potent acute medications and excessive use of acute medications (particularly opioids and barbiturates).

Additional studies evaluating treatment patterns and HRU, particularly new referrals to neurologists or other headache specialists, among newly diagnosed migraine patients is warranted to further understand migraine management among those newly diagnosed and provide insight into improving initial management strat- egies among migraine patients.

Acknowledgement A machine generated summary based on the work of Bonafede, Machaon; McMorrow, Donna; Noxon, Virginia; Desai, Pooja; Sapra, Sandhya; Silberstein, Stephen. 2020 in Neurology and Therapy.

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