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. 2022 Feb;62(2):122-140.
doi: 10.1111/head.14259. Epub 2022 Jan 25.

Diagnosis, consultation, treatment, and impact of migraine in the US: Results of the OVERCOME (US) study

Richard B Lipton  1 , Robert A Nicholson  2 , Michael L Reed  3 , Andre B Araujo  2 , Dena H Jaffe  4 , Douglas E Faries  2 , Dawn C Buse  1 , Robert E Shapiro  5 , Sait Ashina  6   7 , M Janelle Cambron-Mellott  8 , John C Rowland  8 , Eric M Pearlman  2
Affiliations

Diagnosis, consultation, treatment, and impact of migraine in the US: Results of the OVERCOME (US) study

Richard B Lipton et al. Headache. 2022 Feb.

Abstract

Objective: The ObserVational survey of the Epidemiology, tReatment and Care of MigrainE (OVERCOME; United States) study is a multicohort, longitudinal web survey that assesses symptomatology, consulting, diagnosis, treatment, and impact of migraine in the United States.

Background: Regularly updating population-based views of migraine in the United States provides a method for assessing the quality of ongoing migraine care and identifying unmet needs.

Methods: The OVERCOME (US) 2018 migraine cohort involved: (I) creating a demographically representative sample of US adults using quota sampling (n = 97,478), (II) identifying people with active migraine in the past year via a validated migraine diagnostic questionnaire and/or self-reported medical diagnosis of migraine (n = 24,272), and (III) assessing consultation, diagnosis, and treatment of migraine (n = 21,143). The current manuscript evaluated whether those with low frequency episodic migraine (LFEM; 0-3 monthly headache days) differed from other categories on outcomes of interest.

Results: Among the migraine cohort (n = 21,143), 19,888 (94.1%) met our International Classification of Headache Disorders, 3rd edition-based case definition of migraine and 12,905 (61.0%) self-reported a medical diagnosis of migraine. Respondents' mean (SD) age was 42.2 (15.0) years; 15,697 (74.2%) were women. Having at least moderate disability was common (n = 8965; 42.4%) and around half (n = 10,783; 51.0%) had consulted a medical professional for migraine care in the past year. Only 4792 (22.7%) of respondents were currently using a triptan. Overall, 8539 (40.4%) were eligible for migraine preventive medication and 3555 (16.8%) were currently using migraine preventive medication. Those with LFEM differed from moderate and high frequency episodic migraine and chronic migraine on nearly all measures of consulting, diagnosis, and treatment.

Conclusion: The OVERCOME (US) 2018 cohort revealed slow but steady progress in diagnosis and preventive treatment of migraine. However, despite significant impact among the population, many with migraine have unmet needs related to consulting for migraine, migraine diagnosis, and getting potentially beneficial migraine treatment. Moreover, it demonstrated the heterogeneity and varying unmet needs within episodic migraine.

Keywords: diagnosis; episodic migraine; headache; migraine; treatment; unmet need.

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Conflict of interest statement

Richard B. Lipton, MD, has received research support from the National Institutes of Health, the FDA and the National Headache Foundation. He serves as consultant, advisory board member, or has received honoraria or research support from AbbVie/Allergan, Amgen, Biohaven, Dr. Reddy’s Laboratories (Promius), electroCore, Eli Lilly, GlaxoSmithKline, Lilly, Lundbeck, Merck, Novartis, Teva, Vector, and Vedanta Research. He receives royalties from Wolff’s Headache, 8th edition (Oxford University Press, 2009), and Informa. He holds stock/options in Biohaven and CntrlM. Robert A. Nicholson, PhD, is an employee and minor stockholder of Eli Lilly and Company. Michael L. Reed, PhD, has received research support from the National Headache Foundation. He serves as consultant, advisory board member, or has received honoraria or research support from Abbvie/Allergan, Amgen, Dr. Reddy’s Laboratories (Promius), and Eli Lilly. Andre B. Araujo, PhD, reports prior employment and is a minor stockholder of Eli Lilly and Company. Dena H. Jaffe, PhD, is an employee of Kantar Health which receives support from Eli Lilly and Company. Douglas E. Faries, PhD, is an employee and minor stockholder of Eli Lilly and Company. Dawn C. Buse, PhD, has received research support from the FDA and the National Headache Foundation. She serves as consultant, advisory board member, or has received honoraria or research support from AbbVie/Allergan, Amgen, Biohaven, Dr. Reddy’s Laboratories (Promius), Eli Lilly, Lundbeck, Novartis, and Teva. Robert E. Shapiro, MD, PhD, serves as consultant, advisory board member, or has received honoraria or research support from Eli Lilly and Lundbeck. Sait Ashina, MD, serves as consultant, advisory board member, or has received honoraria or research support from AbbVie/Allergan, Amgen, Eli Lilly, Impel NeuroPharma, Novartis, Satsuma, Supernus, and Theranica. M. Janelle Cambron‐Mellott, PhD, is an employee of Kantar Health which receives support from Eli Lilly and Company. John C. Rowland, MS, is an employee of Kantar Health which receives support from Eli Lilly and Company. Eric M. Pearlman, MD, PhD, is an employee and minor stockholder of Eli Lilly and Company.

Figures

FIGURE 1
FIGURE 1
Consort diagram for OVERCOME (US) 2018 migraine cohort wave 1 (N = 21,143). SR‐MD, self‐reported medical diagnosis of migraine. aPhase I = Creating a demographically representative sample of US adults. bTargeted sampling to represent the US adult population in terms of key demographic characteristics (age, sex, race, and geography) were applied. cPhase II = Identifying Respondents with Migraine. dPhase III = Establishing the Migraine Cohort. ICHD‐3, International Classification of Headache Disorders 3rd edition; OVERCOME, Observational survey of the Epidemiology, Treatment, and Care of Migraine; SR‐MD, self‐reported medical diagnosis of migraine [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
MIDAS by monthly headache days stratified by monthly headache days (N = 21,143)
FIGURE 3
FIGURE 3
Lifetime consultation for migraine or headache by specialty, stratified by monthly headache days (N = 21,143). Primary care = primary care, family medicine, internal medicine office/clinic; Neurology = general neurologist office/clinic (not a headache specialist); Headache Specialist = headache specialist office/clinic; Pain Specialist = pain specialist office/clinic; Emergency Department = emergency department at a hospital; Urgent Care = urgent care center; Retail Clinic = community/pharmacy walk‐in/convenient care center
FIGURE 4
FIGURE 4
Migraine preventive medication eligibility and currently taking migraine preventive medication, stratified by monthly headache day frequency (N = 21,143). CM, chronic migraine (≥15 monthly headache days); HFEM, high frequency episodic migraine (8–14 monthly headache days); LFEM, low frequency episodic migraine (0–3 monthly headache days); MFEM, moderate frequency episodic migraine (4–7 monthly headache days). aPreventive eligibility considered monthly headache days and Migraine Disability Assessment (MIDAS) disability grade., , Eligibility was defined three ways: ≥6 monthly headache days, 4–5 monthly headache days with at least some disability (MIDAS ≥6), or 3 monthly headache days with severe disability (MIDAS ≥21). bCurrently taking was defined as “taken or used in the last 3 months.” Migraine preventive medication eligibility considered disability and monthly headache day frequency as specified by the American Headache Society. Currently taking migraine preventive medication use was defined as use within the last 3 months for migraine and is reflective of the percentage among the overall total population within that monthly headache day frequency (regardless of current eligibility for migraine preventive medication)
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