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Assessing Migraine Disability and Prescription Patterns Provides Clinical Insights, Study Says

Allison Inserro
Research shows that primary care physicians prescribe preventive therapy for migraine less often than migraine specialists.
Using a migraine disability assessment (MIDAS) score obtained through a patient questionnaire provides additional insight into migraine care, according to a poster presented at ISPOR 2019. The research showed that primary care physicians prescribe preventive therapy less often than migraine specialists. 

In the retrospective observational study, patients with severe disability made up almost a quarter of the group and had more complex treatment profiles.

Analysis was conducted on deidentified data from the Practice Fusion electronic health record (EHR) database; Practice Fusion is used primarily in small, independent practices, representing roughly equal portions of primary and specialty care. The study sought to better understand migraine treatment patterns in US real-world ambulatory practice.

Using the EHR, data were collected on adult patients with documented migraine and subsequent MIDAS questionnaire between March 2017 and September 2018.

Patients were required to have 12 months or more of activity in the database to establish a baseline period for patient and clinical characteristics. The study included 2731 patients with migraine with MIDAS data. Overall, 84.5% of the patients were female, with an average age of 46.7 years.

Based on answers to 5 questions about level of headache disability, patients were categorized into 4 groups: grade 1 (little or no disability), grade 2 (mild disability), grade 3 (moderate disability), and grade 4 (severe disability). Use of acute and preventive migraine treatments were described by MIDAS score.

Patient distribution by MIDAS score group was:
  • Grade 1, 1161 (42.5%)
  • Grade 2, 424 (15.5%)
  • Grade 3, 477 (17.5%)
  • Grade 4, 669 (24.5%)
Compared with the overall cohort, a larger proportion of patients with severe disability had baseline treatment with acute medications (71.3% vs 67.6%) and preventive medications (70.4% vs 62.0%). Patients with severe disability were more likely to be on 3 or more acute (9.4% vs 7.0%) or 3 or more preventive (17.0% vs 14.5%) therapies.

Primary care physicians had a larger proportion of patients with prior acute therapy than specialists (77.0% vs 56.1%) and a lower proportion of patients with prior preventive therapy (57.7% vs 68.8%). Triptans were the most commonly prescribed acute medication and topiramate was the most commonly prescribed preventive medication.

Another recent study found that patients receiving medications for acute migraine had unmet medical needs.  

One limitation of the study, which was funded by Amgen, is that because Practice Fusion is used mostly by small practices, it may not be generalizable to other care settings. In addition, EHR prescription orders show provider intent and do not reflect whether the prescription was picked up in the pharmacy or taken by the patient.

Reference

Chia VM, Thach A, Yusuf A, Kallenbach L, Bogdanov A. Characteristics of migraine patients with migraine disability assessment (MIDAS) scores in real-world clinical practice. Presented at: ISPOR 2019 Annual Meeting, New Orleans, Louisiana; May 18-22, 2019. Poster PND87.

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