Clinical Characteristics and Treatment Patterns Among Patients Diagnosed With Cluster Headache in U.S. Healthcare Claims Data

Abstract

Objective: To characterize demographics, clinical characteristics, and treatment patterns of patients with cluster headache (CH).

Background: CH is an uncommon trigeminal autonomic cephalalgia with limited evidence-based treatment options. Patients suffer from extremely painful unilateral headache attacks and autonomic symptoms with episodic and chronic cycles.

Design/methods: This retrospective analysis used insurance claims from Truven Health Analytics MarketScan^® research databases from 2009 to 2014. Two cohorts were compared: CH patients (with ≥2 CH claims) were propensity score matched with 4 non-headache controls, all with continuous enrollment for 12 months before and after the date of first CH claim or matched period among controls.

Results: CH patients (N = 7589) were mainly male (57.4%) and 35-64 years old (73.2%), with significantly more claims for comorbid conditions vs controls (N = 30,341), including depressive disorders (19.8% vs 10.0%), sleep disturbances (19.7% vs 9.1%), anxiety disorders (19.2% vs 8.7%), and tobacco use disorders (12.8% vs 5.3%), with 2.5 times greater odds of suicidal ideation (all P < .0001). Odds of drug dependence were 3-fold greater among CH patients (OR = 2.8 [95% CI 2.3-3.4, P < .0001]). CH patients reported significantly greater use of prescription medications compared with controls; 25% of CH patients had >12 unique prescription drug claims. Most commonly prescribed drug classes for CH patients included: opiate agonists (41%), corticosteroids (34%), 5HT-1 agonists (32%), antidepressants (31%), NSAIDs (29%), anticonvulsants (28%), calcium antagonists (27%), and benzodiazepines (22%). Only 30.4% of CH patients received recognized CH treatments without opioids during the 12-month post-index period. These patients were less likely to visit emergency departments or need hospitalizations (26.8%) as compared to CH patients with no pharmacy claims for recognized CH treatments or opioids (33.6%; P < .0001).

Conclusions: The burden of CH is associated with significant co-morbidity, including substance use disorders and suicidal ideation, and treatment patterns indicating low use of recognized CH treatments.

Keywords: claims database; clinical characteristics; cluster headache; matched case-control study; treatment patterns.

Figure 1

(a) Proportions of patients prescribed classes of drugs during the 12‐month post‐index period; for patients with cluster headache vs non‐headache controls: chi‐square test *P < .0001; 5HT‐1 agonist = 5‐hydroxytryptamine‐1 agonist; AA‐NEC = analgesics/antipyretics‐not elsewhere classified (NEC); AA‐Salicylates = analgesics/antipyretics‐salicylates; Antiinflam = anti‐inflammatory agents and combinations; ASH = anxiolytic/sedative/hypnotic NEC; CH = cluster headache; Muscle Relax = skeletal central muscle relaxer; NSAIDs = nonsteroidal anti‐inflammatory drugs. (b) Number of unique prescription drug claims during the 12‐month postindex period. CH = cluster headache.