Barriers to care in episodic and chronic migraine: Results from the Chronic Migraine Epidemiology and Outcomes Study

Buse, Dawn C.; Armand, Cynthia E.; Charleston, Larry; Reed, Michael L.; Fanning, Kristina M.; Adams, Aubrey Manack; Lipton, Richard B.

doi:10.1111/head.14103

Cited by 48 publications

(63 citation statements)

References 52 publications

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“…The mTOQ-4 was derived from the mTOQ-6 by selecting the items that best assessed efficacy: "2-h pain free, " "24-h relief, " "able to plan, " and "in control. " Each item is rated never (1), rarely (2), less than half the time (3), or half the time or more (4). Patients were grouped by baseline mTOQ-4 total scores into the following optimization categories: very poor (0), poor (1-5), moderate (6-7), and maximal (8) than 14% having maximal optimization (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Despite the high burden of migraine, highlighting the need for effective therapy, migraine remains underdiagnosed and undertreated [3]. Less than half of those with migraine seek medical care and receive a migraine diagnosis [4]. Ideally, preventive treatment should reduce the frequency, severity, and duration of migraine episodes, while slowing disease progression [5].…”

Section: Introductionmentioning

confidence: 99%

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Optimization of acute medication use following eptinezumab initiation during a migraine attack: post hoc analysis of the RELIEF study

et al. 2022

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Background The benefits of preventive treatment on the effectiveness of migraine management have rarely been examined. This post hoc analysis investigated the impact of eptinezumab on the optimization of acute medication effectiveness using the 4-item Migraine Treatment Optimization Questionnaire (mTOQ-4) to measure acute medication optimization over 4 weeks post-infusion. Methods RELIEF was a 12-week, phase 3, multicenter, parallel-group, double-blind, placebo-controlled clinical trial conducted in patients aged 18–75 years with a ≥ 1-year history of migraine and 4–15 migraine days per month in the 3 months prior to screening. Patients were randomized 1:1 to a 30-min infusion of eptinezumab 100 mg or placebo within 1–6 h of a qualifying migraine attack. The mTOQ-6 and 6-item Headache Impact Test (HIT-6) were administered at screening visit and week 4. From the mTOQ-6, we calculated the mTOQ-4 using the following items: “2-h pain free,” “24-h relief,” “able to plan,” and “feeling in control” to measure acute medication optimization. Results A total of 238 patients received eptinezumab 100 mg and 226 provided week 4 data; 242 received placebo and 232 provided week 4 data. In the eptinezumab arm, the proportion of patients with moderate/maximal optimization increased from 31.4% at baseline to 58.0% (26.6 percentage point increase) at week 4. The corresponding proportions in the placebo group were 40.5% to 50.4% (9.9 percentage point increase). Eptinezumab treatment was associated with numerically larger improvements in HIT-6 at week 4. Relative improvements with eptinezumab vs. placebo from baseline to week 4 in HIT-6 were greater in those with poor treatment optimization at baseline. Conclusions In comparison with placebo, treatment with eptinezumab was associated with improvements in acute medication optimization as measured by mTOQ and reductions in headache impact, as measured by HIT-6. These benefits were greater in those with poor acute treatment optimization prior to preventive treatment with eptinezumab. Trial registration ClinicalTrials.gov identifier: NCT04152083.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optimization of acute medication use following eptinezumab initiation during a migraine attack: post hoc analysis of the RELIEF study

et al. 2022

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“…Migraine diagnostic delay is due to the time-consuming traditional headache care delivery approach involving a clinic visit, shortage of headache-trained providers, and the growing burden of primary headache disorders worldwide. 2 , 12 , 89 , 90 Given the increase in the global burden of migraine estimated to affect a billion people, 9 it would not be possible to capture every patient with migraine seeking the traditional in-person clinical visits. Hence, the SSI phone interview of patient history is the closest approach analogous to the traditional method of migraine diagnosis—making it our preferred “gold standard” for remote diagnosis in our study.…”

Section: Discussionmentioning

confidence: 99%

“… 9 Diagnostic delay increases the risk of chronic migraine, treatment refractoriness, comorbidities, and medication overuse. 2 Of nine headache-related variables in a 7-year follow-up study, a 6-month delay in migraine diagnosis was the only factor differentiating headache freedom from persistent headache. 10 Another 10-year longitudinal study showed a 2-fold increased risk of persistent migraine in children diagnosed after age 12.…”

Section: Introductionmentioning

confidence: 93%

Diagnostic accuracy of an artificial intelligence online engine in migraine: A multi‐center study

et al. 2022

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Objective: This study assesses the concordance in migraine diagnosis between an online, self-administered, Computer-based, Diagnostic Engine (CDE) and semi-structured interview (SSI) by a headache specialist, both using International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria. Background: Delay in accurate diagnosis is a major barrier to headache care. Accurate computer-based algorithms may help reduce the need for SSI-based encounters to arrive at correct ICHD-3 diagnosis. Methods: Between March 2018 and August 2019, adult participants were recruited from three academic headache centers and the community via advertising to our cross-sectional study. Participants completed two evaluations: phone interview conducted by headache specialists using the SSI and a web-based expert questionnaire and analytics, CDE. Participants were randomly assigned to either the SSI followed by the web-based questionnaire or the web-based questionnaire followed by the SSI. Participants completed protocols a few minutes apart. The concordance in migraine/probable migraine (M/PM) diagnosis between SSI and CDE was measured using Cohen’s kappa statistics. The diagnostic accuracy of CDE was assessed using the SSI as reference standard. Results: Of the 276 participants consented, 212 completed both SSI and CDE (study completion rate = 77%; median age = 32 years [interquartile range: 28–40], female:male ratio = 3:1). Concordance in M/PM diagnosis between SSI and CDE was: κ = 0.83 (95% confidence interval [CI]: 0.75–0.91). CDE diagnostic accuracy: sensitivity = 90.1% (118/131), 95% CI: 83.6%–94.6%; specificity = 95.8% (68/71), 95% CI: 88.1%–99.1%. Positive and negative predictive values = 97.0% (95% CI: 91.3%–99.0%) and 86.6% (95% CI: 79.3%–91.5%), respectively, using identified migraine prevalence of 60%. Assuming a general migraine population prevalence of 10%, positive and negative predictive values were 70.3% (95% CI: 43.9%–87.8%) and 98.9% (95% CI: 98.1%–99.3%), respectively. Conclusion: The SSI and CDE have excellent concordance in diagnosing M/PM. Positive CDE helps rule in M/PM, through high specificity and positive likelihood ratio. A negative CDE helps rule out M/PM through high sensitivity and low negative likelihood ratio. CDE that mimics SSI logic is a valid tool for migraine diagnosis.

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“…Episodic migraine (EM) with or without aura is a diagnosis that can reflect occasional or frequent (<8) migraine days per month and likely makes up the bulk of headache sufferers that regularly present to their doctor with a complaint of head discomfort that disrupts activity. 9,10 Most of the time all that is required for the patient to see this as a manageable problem is a diagnosis and effective acute therapy. 11 When occasional headaches are very severe, leading to frequent hospital presentations, time off work or difficulty in caring for family members, a preventive should be considered.…”

Section: Acute Therapies Diagnosis and Management Principlesmentioning

confidence: 99%

Migraine management: an update for the 2020s

Eller

Cheng

2022

Internal Medicine Journal

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Migraine is a common malady cutting across socioeconomic and ethnic divides in Australia. It is typically diagnosed late with significant impact on quality of life. Management options have emerged over the past several years that promise simpler treatment regimens with less potential for side‐effects. The development of rationally designed migraine preventives is the most significant advance in treatment since the development of the triptans and delivers significant hope to many headache sufferers.

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Barriers to care in episodic and chronic migraine: Results from the Chronic Migraine Epidemiology and Outcomes Study

Cited by 48 publications

References 52 publications

Optimization of acute medication use following eptinezumab initiation during a migraine attack: post hoc analysis of the RELIEF study

Optimization of acute medication use following eptinezumab initiation during a migraine attack: post hoc analysis of the RELIEF study

Diagnostic accuracy of an artificial intelligence online engine in migraine: A multi‐center study

Migraine management: an update for the 2020s

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