What Are Clinicians Prescribing for Headache and Migraine?

A total of 547,558 adults with at least 2 ICD-9-CM/ICD-10-CM diagnostic code claims for headache or migraine were included
A total of 547,558 adults with at least 2 ICD-9-CM/ICD-10-CM diagnostic code claims for headache or migraine were included
The following article features coverage from PAINWeek 2017 in Las Vegas, Nevada. Click here to read more of MPR's conference coverage.

According to results of a retrospective study presented at PAINWeek 2017, opioids are not only prescribed to a large proportion of patients diagnosed with headache (H) and/or migraine (M), but are also more commonly used than triptan medications.

During the analysis, 547,558 adults with at least two ICD-9-CM or ICD-10-CM diagnostic code claims for H or M were identified in the HealthCore Integrated Research Database. Analysis included the demographics, comorbidities, and prescription medication use of these patients, as well as the proportion of days covered (PDC) ≥80% and persistence (no gap of ≥30 days in preventive medication supply).

The five mutually exclusive cohorts were H only (n=365,091), M only (n=94,492), H/M on the same day (H/M, n=7,461), H then M (H-M, n=46,656) and M then H (M-H, n=33,858).

The study authors reported, “Approximately 11% of patients with a first diagnosis of H had a subsequent M diagnosis, and 25% of patients with a first diagnosis of M had a subsequent H diagnosis.” The median time found between diagnoses was 231 days for the H-M group compared to 252 days for the M-H group. Additionally, patients in the H only group were found to have a higher rate of vascular comorbidities, such as hypertension/dyslipidemia, ischemic heart disease, and cerebrovascular disease, compared to the other cohorts.

Medication use was also found to vary among patients in different cohorts. Results of the study found that only 4% of H only patients used triptan medications compared to 46–50% of patients in the other 4 groups. The study authors reported, “Opioid use was fairly high in all groups [H (61%), M (57%), H/M (74%), H-M (71%) and M-H (74%)].” They added, “Triptan and opioid use between diagnoses among H-M was 18% and 56%, respectively, and among M-H 38% and 56%, respectively.” 

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Preventive medication use data obtained during the study was also reported. It was found that 47% of H patients, 49% of M patients, 65% of H/M patients, 69% of H-M patients, and 68% of M-H patients had ≥1 preventive medication prescription after last diagnosis. Top preventive medication choices included ACE inhibitors for H patients (18%), beta-blockers for M patients (17%), and antiepileptics for H/M, H-M, and M-H patients (31%, 33%, and 33%, respectively).  

The study authors also found that the proportion of patients, respectively, with PDC ≥80% and persistent to preventive medications following final diagnosis was low [H (22%, 2%), M (20%, 2%), H/M (13%,2%), H-M (16%, 1%) and M-H (17%, 3%)].

Opioid prescribing is very common among patients diagnosed with H or M. Because preventive medication use varies substantially and medication adherence is low, therapy for patients diagnosed with H and M should be optimized.

Read more of MPR's coverage of PAINWeek 2017 by visiting the conference page.

Reference

1.   Morrow PA, Chung H, Visaria J, et al. Medication Use among Patients Diagnosed with Headache and Migraine in a Large National Commercial Database: A Retrospective Study. Eli Lilly and Company. Indianapolis, IN, USA.