Assessing barriers to chronic migraine consultation, diagnosis, and treatment: Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study

David W. Dodick, Elizabeth W. Loder, Aubrey Manack Adams, Dawn C. Buse, Kristina M. Fanning, Michael L. Reed, Richard B. Lipton

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Objective To assess the rates and predictors of traversing steps essential to good medical care for chronic migraine, including: (1) medical consultation, (2) accurate diagnosis, and (3) minimal pharmacologic treatment. Candidate predictors included socioeconomic, demographic, and headache-specific variables. Background Previous research has established that barriers to effective management for episodic migraine include the absence of health insurance, lack of appropriate medical consultation, failure to receive an accurate diagnosis, and not being offered a regimen with acute and preventive treatments. Methods/Design The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, a longitudinal web-based panel study of migraine, included a cross-sectional module focused on patterns of and barriers to medical care. Participants eligible for this analysis met the study criteria for chronic migraine, had evidence of headache-related disability, and provided data on health insurance status. The main outcomes in the current analysis included the proportion of respondents who sought consultation for headache with a designated healthcare professional, self-reported receiving a diagnosis of chronic or transformed migraine, and received minimal pharmacologic treatment for headache with a focus on prescribed acute and preventive treatments. Results In the CaMEO Study, 80,783 respondents provided study data, 16,789 (20.8% of respondents) met criteria for migraine, and 1476 (8.8% of those with migraine) met chronic migraine criteria. In total, 1254 participants (85.0% of those with chronic migraine) met inclusion criteria for this analysis. Of those, 512 respondents (40.8%) reported currently consulting with a healthcare professional for headache. Odds of consulting increased with increasing age (OR 1.02; 95% CI 1.01-1.03), body mass index (BMI) (OR 1.01; 95% CI 1.00-1.03), migraine-related disability (OR 1.02; 95% CI 1.00-1.04), and migraine severity (OR 1.16; 95% CI 1.11-1.22) and presence of health insurance (OR 4.61; 95% CI 3.05-6.96). Among those consulting a healthcare professional, 126 (24.6%) received an accurate diagnosis and 56 of those with a correct diagnosis (44.4%) received both acute and preventive pharmacologic treatments; odds of a CM diagnosis were higher for women (OR 1.93; 95% CI 1.03-3.61), those with greater migraine severity (OR 1.25; 95% CI 1.14-1.37), and those currently consulting a specialist (OR 2.38; 95% CI 1.54-3.69). No predictors of receiving appropriate treatment were identified among those currently consulting. Among our sample of people with chronic migraine, only 56 (4.5%) individuals successfully traversed the series of 3 barriers to successful chronic migraine care (ie, consulted a healthcare professional for migraine, received an accurate diagnosis, and were prescribed minimal acute and preventive pharmacologic treatments). Conclusion Our findings suggest that

Original languageEnglish (US)
Pages (from-to)821-834
Number of pages14
JournalHeadache
Volume56
Issue number5
DOIs
StatePublished - May 1 2016

Fingerprint

Migraine Disorders
Epidemiology
Referral and Consultation
Outcome Assessment (Health Care)
Headache
Therapeutics
Health Insurance
Delivery of Health Care
Insurance Coverage
Health Status
Body Mass Index

Keywords

  • acute medication
  • barrier to care
  • chronic migraine
  • headache-related disability
  • migraine
  • preventive medication

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Assessing barriers to chronic migraine consultation, diagnosis, and treatment : Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. / Dodick, David W.; Loder, Elizabeth W.; Manack Adams, Aubrey; Buse, Dawn C.; Fanning, Kristina M.; Reed, Michael L.; Lipton, Richard B.

In: Headache, Vol. 56, No. 5, 01.05.2016, p. 821-834.

Research output: Contribution to journalArticle

Dodick, David W. ; Loder, Elizabeth W. ; Manack Adams, Aubrey ; Buse, Dawn C. ; Fanning, Kristina M. ; Reed, Michael L. ; Lipton, Richard B. / Assessing barriers to chronic migraine consultation, diagnosis, and treatment : Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. In: Headache. 2016 ; Vol. 56, No. 5. pp. 821-834.
@article{f4ef039c80af418998aaae40373194be,
title = "Assessing barriers to chronic migraine consultation, diagnosis, and treatment: Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study",
abstract = "Objective To assess the rates and predictors of traversing steps essential to good medical care for chronic migraine, including: (1) medical consultation, (2) accurate diagnosis, and (3) minimal pharmacologic treatment. Candidate predictors included socioeconomic, demographic, and headache-specific variables. Background Previous research has established that barriers to effective management for episodic migraine include the absence of health insurance, lack of appropriate medical consultation, failure to receive an accurate diagnosis, and not being offered a regimen with acute and preventive treatments. Methods/Design The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, a longitudinal web-based panel study of migraine, included a cross-sectional module focused on patterns of and barriers to medical care. Participants eligible for this analysis met the study criteria for chronic migraine, had evidence of headache-related disability, and provided data on health insurance status. The main outcomes in the current analysis included the proportion of respondents who sought consultation for headache with a designated healthcare professional, self-reported receiving a diagnosis of chronic or transformed migraine, and received minimal pharmacologic treatment for headache with a focus on prescribed acute and preventive treatments. Results In the CaMEO Study, 80,783 respondents provided study data, 16,789 (20.8{\%} of respondents) met criteria for migraine, and 1476 (8.8{\%} of those with migraine) met chronic migraine criteria. In total, 1254 participants (85.0{\%} of those with chronic migraine) met inclusion criteria for this analysis. Of those, 512 respondents (40.8{\%}) reported currently consulting with a healthcare professional for headache. Odds of consulting increased with increasing age (OR 1.02; 95{\%} CI 1.01-1.03), body mass index (BMI) (OR 1.01; 95{\%} CI 1.00-1.03), migraine-related disability (OR 1.02; 95{\%} CI 1.00-1.04), and migraine severity (OR 1.16; 95{\%} CI 1.11-1.22) and presence of health insurance (OR 4.61; 95{\%} CI 3.05-6.96). Among those consulting a healthcare professional, 126 (24.6{\%}) received an accurate diagnosis and 56 of those with a correct diagnosis (44.4{\%}) received both acute and preventive pharmacologic treatments; odds of a CM diagnosis were higher for women (OR 1.93; 95{\%} CI 1.03-3.61), those with greater migraine severity (OR 1.25; 95{\%} CI 1.14-1.37), and those currently consulting a specialist (OR 2.38; 95{\%} CI 1.54-3.69). No predictors of receiving appropriate treatment were identified among those currently consulting. Among our sample of people with chronic migraine, only 56 (4.5{\%}) individuals successfully traversed the series of 3 barriers to successful chronic migraine care (ie, consulted a healthcare professional for migraine, received an accurate diagnosis, and were prescribed minimal acute and preventive pharmacologic treatments). Conclusion Our findings suggest that",
keywords = "acute medication, barrier to care, chronic migraine, headache-related disability, migraine, preventive medication",
author = "Dodick, {David W.} and Loder, {Elizabeth W.} and {Manack Adams}, Aubrey and Buse, {Dawn C.} and Fanning, {Kristina M.} and Reed, {Michael L.} and Lipton, {Richard B.}",
year = "2016",
month = "5",
day = "1",
doi = "10.1111/head.12774",
language = "English (US)",
volume = "56",
pages = "821--834",
journal = "Headache",
issn = "0017-8748",
publisher = "Wiley-Blackwell",
number = "5",

}

TY - JOUR

T1 - Assessing barriers to chronic migraine consultation, diagnosis, and treatment

T2 - Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study

AU - Dodick, David W.

AU - Loder, Elizabeth W.

AU - Manack Adams, Aubrey

AU - Buse, Dawn C.

AU - Fanning, Kristina M.

AU - Reed, Michael L.

AU - Lipton, Richard B.

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Objective To assess the rates and predictors of traversing steps essential to good medical care for chronic migraine, including: (1) medical consultation, (2) accurate diagnosis, and (3) minimal pharmacologic treatment. Candidate predictors included socioeconomic, demographic, and headache-specific variables. Background Previous research has established that barriers to effective management for episodic migraine include the absence of health insurance, lack of appropriate medical consultation, failure to receive an accurate diagnosis, and not being offered a regimen with acute and preventive treatments. Methods/Design The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, a longitudinal web-based panel study of migraine, included a cross-sectional module focused on patterns of and barriers to medical care. Participants eligible for this analysis met the study criteria for chronic migraine, had evidence of headache-related disability, and provided data on health insurance status. The main outcomes in the current analysis included the proportion of respondents who sought consultation for headache with a designated healthcare professional, self-reported receiving a diagnosis of chronic or transformed migraine, and received minimal pharmacologic treatment for headache with a focus on prescribed acute and preventive treatments. Results In the CaMEO Study, 80,783 respondents provided study data, 16,789 (20.8% of respondents) met criteria for migraine, and 1476 (8.8% of those with migraine) met chronic migraine criteria. In total, 1254 participants (85.0% of those with chronic migraine) met inclusion criteria for this analysis. Of those, 512 respondents (40.8%) reported currently consulting with a healthcare professional for headache. Odds of consulting increased with increasing age (OR 1.02; 95% CI 1.01-1.03), body mass index (BMI) (OR 1.01; 95% CI 1.00-1.03), migraine-related disability (OR 1.02; 95% CI 1.00-1.04), and migraine severity (OR 1.16; 95% CI 1.11-1.22) and presence of health insurance (OR 4.61; 95% CI 3.05-6.96). Among those consulting a healthcare professional, 126 (24.6%) received an accurate diagnosis and 56 of those with a correct diagnosis (44.4%) received both acute and preventive pharmacologic treatments; odds of a CM diagnosis were higher for women (OR 1.93; 95% CI 1.03-3.61), those with greater migraine severity (OR 1.25; 95% CI 1.14-1.37), and those currently consulting a specialist (OR 2.38; 95% CI 1.54-3.69). No predictors of receiving appropriate treatment were identified among those currently consulting. Among our sample of people with chronic migraine, only 56 (4.5%) individuals successfully traversed the series of 3 barriers to successful chronic migraine care (ie, consulted a healthcare professional for migraine, received an accurate diagnosis, and were prescribed minimal acute and preventive pharmacologic treatments). Conclusion Our findings suggest that

AB - Objective To assess the rates and predictors of traversing steps essential to good medical care for chronic migraine, including: (1) medical consultation, (2) accurate diagnosis, and (3) minimal pharmacologic treatment. Candidate predictors included socioeconomic, demographic, and headache-specific variables. Background Previous research has established that barriers to effective management for episodic migraine include the absence of health insurance, lack of appropriate medical consultation, failure to receive an accurate diagnosis, and not being offered a regimen with acute and preventive treatments. Methods/Design The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, a longitudinal web-based panel study of migraine, included a cross-sectional module focused on patterns of and barriers to medical care. Participants eligible for this analysis met the study criteria for chronic migraine, had evidence of headache-related disability, and provided data on health insurance status. The main outcomes in the current analysis included the proportion of respondents who sought consultation for headache with a designated healthcare professional, self-reported receiving a diagnosis of chronic or transformed migraine, and received minimal pharmacologic treatment for headache with a focus on prescribed acute and preventive treatments. Results In the CaMEO Study, 80,783 respondents provided study data, 16,789 (20.8% of respondents) met criteria for migraine, and 1476 (8.8% of those with migraine) met chronic migraine criteria. In total, 1254 participants (85.0% of those with chronic migraine) met inclusion criteria for this analysis. Of those, 512 respondents (40.8%) reported currently consulting with a healthcare professional for headache. Odds of consulting increased with increasing age (OR 1.02; 95% CI 1.01-1.03), body mass index (BMI) (OR 1.01; 95% CI 1.00-1.03), migraine-related disability (OR 1.02; 95% CI 1.00-1.04), and migraine severity (OR 1.16; 95% CI 1.11-1.22) and presence of health insurance (OR 4.61; 95% CI 3.05-6.96). Among those consulting a healthcare professional, 126 (24.6%) received an accurate diagnosis and 56 of those with a correct diagnosis (44.4%) received both acute and preventive pharmacologic treatments; odds of a CM diagnosis were higher for women (OR 1.93; 95% CI 1.03-3.61), those with greater migraine severity (OR 1.25; 95% CI 1.14-1.37), and those currently consulting a specialist (OR 2.38; 95% CI 1.54-3.69). No predictors of receiving appropriate treatment were identified among those currently consulting. Among our sample of people with chronic migraine, only 56 (4.5%) individuals successfully traversed the series of 3 barriers to successful chronic migraine care (ie, consulted a healthcare professional for migraine, received an accurate diagnosis, and were prescribed minimal acute and preventive pharmacologic treatments). Conclusion Our findings suggest that

KW - acute medication

KW - barrier to care

KW - chronic migraine

KW - headache-related disability

KW - migraine

KW - preventive medication

UR - http://www.scopus.com/inward/record.url?scp=84964923707&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84964923707&partnerID=8YFLogxK

U2 - 10.1111/head.12774

DO - 10.1111/head.12774

M3 - Article

AN - SCOPUS:84964923707

VL - 56

SP - 821

EP - 834

JO - Headache

JF - Headache

SN - 0017-8748

IS - 5

ER -