Neurologist Care Predictive in Migraine Medication Initiation

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Researchers sought to determine whether demographics and initiation of acute medication use could predict initiation of preventive migraine medication.

Regular acute medication refills, specific comorbidity diagnoses, headache/migraine-specific emergency department (ED) use, and neurologist care are predictors of preventive migraine medications (PMM) initiation in the year after initial migraine diagnosis, according to study results published in Current Medical Research and Opinion.

In this retrospective observational cohort study, using a commercial and Medicare claims database, researchers identified adults age ≥18 years with ≥1 migraine diagnosis during an index period from January 1, 2011 through December 31, 2013 (N=147,923). Date of first migraine diagnosis and date of first PMM were the 2 index dates. Investigators divided patients into 2 subgroups: individuals who initiated a PMM within 1 year of migraine diagnosis (n=43,660), and those who did not initiate a PMM (n=104,263).

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Best fit model for predicting PMM initiation included female sex (odds ratio [OR] 1.181; 95% CI, 1.144-1.218), headache diagnosis before migraine diagnosis (OR 1.538; 95% CI, 1.498-1.579), sleep disorder (OR 1.206; 95% CI, 1.161-1.252), headache or migraine-specific ED visit (OR 1.224; 95% CI, 1.168-1.283), neurologist visit (OR 1.502; 95% CI, 1.459-1.547), and acute medication refills with <90-day gap (OR 1.509; 95% CI, 1.470-1.549), each measured at 1-year before first PMM.

This study was limited by the data available from an administrative US healthcare database, which is used for medical billing purposes. Data on previous diagnoses, previous PMM use, level of headache frequency, and degree of disability were unknown. Higher specificity and sensitivity were achieved with 2 migraine diagnostic codes (or 1 inpatient) required to identify the study population. Researchers did not separate episodic and chronic migraine because the International Classification of Diseases, Ninth Revision code for chronic migraine was underused. Patients may have received a diagnosis before the premigraine diagnosis data period. These findings may not apply to patients with long-standing migraine in new need of a PMM.

Predictive factors of PMM initiation in the year after incident migraine diagnosis are regular acute medication refills, comorbidity diagnoses, headache/migraine-specific ED use, and neurologist care. Future research is needed to further investigate the ability to identify patients with migraine in need of preventive care within the healthcare system; receiving timely PMM care within the disease course has the potential to reduce healthcare resource use, prevent disease progression, and improve outcomes.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Ford JH, Schroeder K, Buse DC, et al. Predicting initiation of preventive migraine medications: exploratory study in a large US medical claims database [published online August 17, 2019]. Curr Med Res Opin. doi: 10.1080/03007995.2019.1657716