Why Do Migraineurs Hesitate to Seek Care?

Research presented at this year’s Annual Scientific Meeting of the American Headache Society found that hesitating to consult for migraine care is common among those with the condition. The abstract was presented at the virtual meeting, which took place June 3-6, 2021.

“Understanding the proportion of people with migraine who hesitate to consult for migraine and their reasons for hesitating are important steps toward addressing barriers to care,” the researchers wrote.

To address this knowledge gap, the authors assessed who hesitated to consult for migraine care over the course of a year and the reasons endorsed for hesitating. In addition, because some who hesitated ended up consulting for care, the researchers looked into what factors differentiated those who hesitated and did consult from those who hesitated and did not consult.

Data were gleaned from 2018 and 2019 cohorts of the ObserVational survey of the Epidemiology, tReatment and Care Of MigrainE (OVERCOME) US study. The web-based survey was conducted among representative US samples while respondents were identified based on International Classification of Headache Disorders-3 criteria and/or a self-reported diagnosis by a health care professional.

A total of 39,494 migraineurs completed the survey and were divided by consulting for headache care in the last 12 months (C-YES) or not (C-NO). Those who responded they did hesitate to seek out care selected reasons from a list of 14 options. The mean patient age was 39.3 years and the majority (74.4%) were female.

Nearly half of respondents (n = 17,951; 45.5%) said they hesitated to consult for migraine. Of these individuals, 10,425 (58.1%) consulted in the last year and 7495 (41.8%) did not.

The 7 most common reasons for hesitating to consult for migraine were:

• I wanted to take care of them (migraine symptoms) on my own
• I felt my migraine would not be taken seriously
• I could not afford it/ did not want to spend the money
• I did not have health insurance/it did not cover the cost
• I was afraid they might diagnose me with something serious
• I was too busy

“More than 25% of respondents endorsed the following: wanting to care for migraine on their own (45.2%), concerned about not being taken seriously (34.9%), not thinking their migraine was serious enough to warrant consulting (29.4%), and concerned about costs (28.7%),” the researchers wrote.

Additional analyses revealed:

• Reasons for hesitating that were more common in those who consulted included fear of not being taken seriously (C-YES, 37.7% vs C-NO, 31%) and fear that something serious was wrong (C-YES, 21.7% vs C-NO, 15.4%)
• Reasons more common among those who did not consult were wanting to care for migraine on their own (C-NO, 48.3% vs C-YES, 43%) and not thinking their migraine was serious enough (C-NO, 35.6% vs C-YES, 24.9%).
• At least moderate disability (C-YES, 66.1%; C-NO, 42.2%), having health insurance (C- YES, 87.4%; C-NO, 78.4%), receiving a migraine diagnosis (C-YES, 73%; C-NO, 45.9%), poor/very poor migraine Treatment Optimization Questionnaire scores (C-YES, 64.5%; C-NO, 50.2%), having nausea (C-YES, 83.5%; C-NO, 75.9%), and having consulted for any health care in the last 12 months (C-YES, 100%; C-NO, 64.5%) were all significantly associated with consulting (P < .001 for all)

The finding that patients feeling their migraine would not be taken seriously despite the majority of participants being disabled by migraine—on average 1 day a week or more—was “especially concerning,” according to the authors.

“Further efforts are needed to motivate individuals to consult for migraine care and to ensure patients and providers communicate about migraine, so patients feel they are taken seriously when consulting for migraine care,” they concluded.

Reference

Shapiro RE, Nicholson RA, Zagar AJ, et al. Reasons for hesitating to consult for migraine care: results of the OVERCOME (US) study. Presented at: American Headache Society 2021 Virtual Annual Scientific Meeting (63rd); June 3-6, 2021. Accessed June 7, 2021. https://headachejournal.onlinelibrary.wiley.com/doi/epdf/10.1111/head.14130