Migraine is a common neurological disorder that occurs in approximately 12% of adults in western countries and can significantly impair the quality of life of the patients. 1,2) In Korea, 6.1% of the population suffers from migraine headaches at least once a year, and women roughly have three times higher incidence of migraine than men. It is most frequent in women aged 40-49 years and men aged 19-29 years. 3) This neurological disorder has a broad range of severity and symptoms; it is a unilateral, pulsatile pain, and aggravated by routine physical activity. 4) In addition, migraine is accompanied by one or more additional symptoms such as nausea, vomiting, abdominal pain, dizziness, photophobia, and phonophobia. 4) According to the International Classification of Headache Disorders 3rd edition (ICHD-3), the two major subtypes of migraine are migraine without aura (MWoA) and migraine with aura (MWA), 5) and they are not completely distinct and exclusive. 5) Appropriate acute therapy for migraine headaches can abort migraine attacks and suitable preventive treatment can reduce migraine frequency, headache severity, and health care costs. 6) Acute treatments of migraines include serotonin receptor agonists (triptans), ergot alkaloids, non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids. 7,8) The American Academy of Neurology (AAN) has published guidelines for preventing migraines in 2012. 9) The AAN guidelines recommend metoprolol, propranolol, timolol, valproic acid/valproate/ divalproex, topiramate with strong evidence, and atenolol, nadolol, amitriptyline, venlafaxine with moderate evidence. 9)

This study analyzed the pattern of attention-deficit/hyperactivity disorder (ADHD) medication initiation in adult patients with ADHD after the reimbursement criteria change and identified the influencing factors associated with it using the claim data. We identified 243 adult patients with ADHD who had not been prescribed ADHD drugs before 1 September 2016. We conducted Kaplan–Meier survival analysis to calculate the time to initial prescription of ADHD medications, and Cox proportional hazard regression analysis to estimate the influencing factors. Approximately one-third of the patients (n = 76, 31.3%) were first prescribed ADHD medications after reimbursement approval, and 40 of them (16.5%) started treatment with osmotic release oral system methylphenidate. The patient’s age group (30–39 years) and the status of diagnosis before the index date were associated with early initiation of pharmacotherapy. The odds of starting ADHD medications increased approximately 2.7-fold in the 30–39 age group and 0.2-fold in the case of patients who were diagnosed before the approval. Our findings show that both diagnosis and treatment of adult ADHD remains inadequate despite the change in reimbursement criteria. Improving awareness of adult ADHD among both the public and the professionals is essential to increase its chances of diagnosis and treatment.