Disability and Dissatisfaction With Care Reported in Chronic Migraine

Patients with chronic migraine (CM) report higher levels of disability and less overall satisfaction with care and access to care compared with patients with episodic migraine (EM), according to a study published in Headache.

In this cross-sectional survey study, investigators identified patients aged ≥18 years with any migraine-specific ICD-9 or ICD-10 diagnosis code within the Mayo Clinic Employee and Community Health practice between May 1, 2014, and April 1, 2017 (N=516). Characteristics of migraine symptomology and experience were assessed using the history of self-reported migraine aura, headache frequency, and severity.

Patients reporting >15 headache days per month for more than 3 months were categorized as having CM, and the remaining patients were categorized as having EM. Patients with EM who reported an average of >2 headache days per week were defined as having frequent EM, while patients reporting an average of ≤2 headache days per week were defined as having infrequent EM.

Migraine Disability Assessment and the Headache Impact Test-6 were used to assess disability and quality of life; utilization of the Family Medical Leave Act was used as a proxy measure for how migraine may have impacted the patient’s ability to work. Investigators also assessed types of care consultation, utilization of alternative therapies, patient confidence in their current treatment plan, and ability to self-manage.

Patients with CM were more likely than patients with EM to report care from a neurologist (76/110 [69%] vs 229/406 [56%]; P =.0026). According to the Migraine Disability Assessment and Headache Impact Test-6 questionnaires, the level of disability was significantly higher in patients with CM compared with patients with EM (P <.0001 for each). Only 13% (65/516) of all patients reported using the Family Medical Leave Act, and usage did not differ across CM vs EM (P =.1913), but patients with frequent EM reported higher usage than patients with infrequent EM (20/237 [17%] vs 26/158 [9%]; P =.0242).

Patients with CM were less likely to report that they were very satisfied with their care than patients with EM (16/110 [38%] vs 156/406 [66%]; P =.0002). Patients with CM were also less likely to report that they were very satisfied with their access to care compared with patients with EM (17/110 [33%] vs 176/406 [68%]; P <.0001).

Limitations of this study are the patient-reported headache frequency used to diagnose headache type and a relatively low survey response rate that may have biased the findings.

Patients with CM were found to be less satisfied with the current care model than patients with EM, which supports the development and further study of care pathways that align migraine care expertise and resources that are based on migraine frequency and disability. Additional improvement opportunities could be elucidated by qualitative studies to further explore the dissatisfaction of patients with CM.

Reference

Young NP, Philpot LM, Vierkant RA, et al. Episodic and chronic migraine in primary care [published online April 29, 2019]. Headache. doi: 10.1111/head.13543