Abstract Details

Title Assessing Barriers to Care in Episodic and Chronic Migraine: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study

Topic Headache

Presentation(s) S15 - Headache 2 (2:32 PM-2:40 PM)

Poster/Presentation
Number 004

Background Barriers to good outcomes in migraine include lack of appropriate medical consultation, failure to receive an accurate diagnosis, not being offered a regimen with acute and preventive pharmacologic treatments, and not avoiding acute medication overuse.

Objective To assess rates of traversing fundamental barriers to good medical outcomes in individuals with episodic (EM) and chronic migraine (CM), and evaluate the potential impact of sociodemographic barriers.

Design/Methods Respondents to the US Internet-based Chronic Migraine Epidemiology and Outcomes (CaMEO) Study who met modified International Classification of Headache Disorders, 3rd edition, criteria for migraine, had a Migraine Disability Assessment score of grade ≥2, and provided health insurance status were included. Proportions of EM and CM respondents who successfully traversed each barrier were calculated and the effects of sociodemographic characteristics were examined.

Results Among 16,789 respondents with migraine, 9184 (EM: 7930; CM: 1254) met eligibility criteria. Current headache consultation was reported by 27.6% (2187/7930) of EM and 40.8% (512/1254) of CM respondents. Among consulters, 75.7% (1655/2187) of the EM sample and 32.8% (168/512) of the CM sample were accurately diagnosed. Among diagnosed consulters, 59.9% (992/1655) of the EM group and 54.2% (91/168) of the CM group reported minimally appropriate acute and preventive pharmacologic treatment. Among diagnosed and treated consulters, 31.8% (315/992) of persons with EM and 74.7% (68/91) of those with CM met acute medication overuse criteria. Only 8.5% (677/7930) of EM and 1.8% (23/1254) of CM respondents traversed all 4 barriers. Higher income was associated with increased rates of traversing each barrier (P<0.05).

Conclusions These results show that less than 8% of people with migraine traverse all 4 treatment barriers and sociodemographic factors were significantly associated with the likelihood of traversing these barriers. Efforts to improve care should focus on increasing consultation and diagnosis rates, improving delivery of guideline-based acute and preventive treatment, and avoidance of medication overuse.

Authors/Disclosures
Dawn C. Buse, PhD (Dawn C. Buse, PhD) PRESENTER	Dr. Buse has received personal compensation for serving as an employee of Vector Psychometric Group. Dr. Buse has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie-Allergan. Dr. Buse has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Buse has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lilly. Dr. Buse has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lundbeck. Dr. Buse has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Collegium. Dr. Buse has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva. Dr. Buse has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lilly. Dr. Buse has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie-Allergan. Dr. Buse has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck. Dr. Buse has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Pain and Headache Reports. The institution of Dr. Buse has received research support from Amgen. The institution of Dr. Buse has received research support from FDA. The institution of Dr. Buse has received research support from National Headache Foundation.
Cynthia E. Armand, MD (Montefiore Medical Headache Center)	Dr. Armand has received personal compensation in the range of $0-$499 for serving as a Consultant for Abbvie. Dr. Armand has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TEVA. Dr. Armand has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Spire Learning. Dr. Armand has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology.
Larry Charleston IV, MD, MSc, FAHS (Michigan State University College of Human Medicine)	Dr. Charleston has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Allergan/AbbVie. Dr. Charleston has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biohaven Biopharmaceuticals. Dr. Charleston has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Teva Pharmaceuticals. Dr. Charleston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal Pharmaceuticals. Dr. Charleston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Satsuma Pharmaceuticals. Dr. Charleston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for LinPharma. Dr. Charleston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Haleon. Dr. Charleston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pfizer. Dr. Charleston has a non-compensated relationship as a Associate Editor with Headache Journal: The Journal of Head and Face Pain that is relevant to AAN interests or activities. Dr. Charleston has a non-compensated relationship as a Board Member at Large with Alliance for Headache Disorders Advocacy that is relevant to AAN interests or activities. Dr. Charleston has a non-compensated relationship as a Board Member with Clinical Neurological Society of America that is relevant to AAN interests or activities.
Michael L. Reed, PhD (Vedanta Research)	The institution of Dr. Reed has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Eli Lilly. The institution of Dr. Reed has received research support from Allergan. The institution of Dr. Reed has received research support from Dr Reddy's Labs/Promius. The institution of Dr. Reed has received research support from Allay Lamp. Dr. Reed has a non-compensated relationship as a Research Analyst with National Headache Foundation that is relevant to AAN interests or activities.
Kristina M. Fanning, PhD (MIST Reserach)	The institution of Kristina Fanning has received research support from Abbvie. The institution of Kristina Fanning has received research support from NYC Langone Health . The institution of Kristina Fanning has received research support from Allay Lamp. The institution of Kristina Fanning has received research support from Juva Health.
Aubrey Adams, PhD	Dr. Manack Adams has received personal compensation for serving as an employee of Abbvie. Dr. Manack Adams has stock in Abbvie.
Richard B. Lipton, MD, FAAN (Albert Einstein College of Medicine)	Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Allergan/Abbvie. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Amgen. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biohaven. Dr. Lipton has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Eli Lilly. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lundbeck. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for GlaxoSmithKline. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Teva. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Vedanta. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Grifols. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Axon. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Satsuma. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cool Tech. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BDSI. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Linpharma. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Allergan/Abbvie. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biohaven. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck. Dr. Lipton has stock in Biohaven. Dr. Lipton has stock in Manistee. Dr. Lipton has stock in Axon. Dr. Lipton has stock in CoolTech. The institution of Dr. Lipton has received research support from Teva. The institution of Dr. Lipton has received research support from Amgen. The institution of Dr. Lipton has received research support from Allergan/Abbvie. The institution of Dr. Lipton has received research support from Gammacore. The institution of Dr. Lipton has received research support from Axsome. The institution of Dr. Lipton has received research support from Charleston Labs. The institution of Dr. Lipton has received research support from Eli Lilly. The institution of Dr. Lipton has received research support from Satsuma. The institution of Dr. Lipton has received research support from NIH . The institution of Dr. Lipton has received research support from Veterans Administration. Dr. Lipton has received publishing royalties from a publication relating to health care.