Nearly Half of People With Migraine Don’t Seek Care

Many people with migraine hesitated to seek care, mainly because they chose self-management or were concerned their migraine wouldn’t be taken seriously, a population-based survey showed.

Nearly half (45%) of participants in the OVERCOME (U.S.) study hesitated to seek migraine care and of those, 42% did not seek migraine care in the preceding 12 months, reported Robert Shapiro, MD, PhD, of the University of Vermont in Burlington, in a presentation at the American Headache Society virtual meeting.

People who hesitated to get migraine care said they wanted to take care of symptoms on their own (45%) or were concerned their migraine would not be taken seriously (35%), he said. Many who did not seek migraine care experienced at least moderate disability on the Migraine Disability Assessment (MIDAS) test, a measure of the effect of headache attacks on daily school, work, home, or social activities over 3 months.

“Given that nearly half of survey respondents hesitated to seek migraine care, we urgently need to understand the bases for these barriers and promote more effective dialogue between healthcare providers and people with migraine to improve their health outcomes,” Shapiro noted.

OVERCOME was a prospective, multi-cohort, web-based survey conducted in a representative U.S. sample in 2018 and 2019. Survey respondents had one or more headache or migraine attack in the past 12 months. Most respondents (94.6%) met criteria based on a validated migraine screener using International Classification of Headache Disorders (ICHD-3) criteria. In addition, 60% had self-reported a migraine diagnosis by a healthcare provider.

Of a total study population of 41,925 people, 39,494 respondents indicated whether they had hesitated to consult for migraine care. Participants who hesitated to get help mainly were female (74%) with an average age of 39. Nearly half (45%) had full-time employment and about a third (32%) had a college degree. Mean BMI was 29.2, and 19.5% currently used marijuana or cannabidiol.

About half (52%) had up to 3 monthly migraine days; 21% had 4-7 days, 13% had 8-14 days, and 14% had 15 days or more. More than 80% had nausea, photophobia, or phonophobia with their attacks. Among participants who felt their migraine would not be taken seriously, most were disabled by migraine on average 1 or more day a week.

Other major reasons people hesitated to get migraine care included not thinking their migraine was serious or painful enough (29%), inability to afford care (29%), inadequate health insurance coverage (21%), and fear of being diagnosed with something serious (19%).

Of participants who eventually did consult for migraine even though they hesitated, factors associated with their decision to get help included a previous migraine diagnosis, moderate or severe disability, and having health insurance.

Several measures may increase migraine consulting and improve health outcomes, Shapiro suggested. “These might include ensuring that an accurate diagnosis of migraine is made, taking migraine seriously — that is, reducing stigma — and reducing institutional barriers and costs,” he said.

The study had several limitations. Survey data were self-reported and subject to recall and selection bias. In addition, the researchers did not evaluate information about the time lag to consulting.