E-Poster Title: Epidemiology, Treatment Landscape, and Healthcare Resource Utilization for Patients with Migraine in Canada
Migraine is a common, debilitating headache disorder that is the third leading cause of global disability and the leading cause of years lived with disability (YLDs) among those 15-49 years of age.1,2,3 Migraine is characterized by intense headaches lasting from a few hours to multiple days, can be associated with nausea, vomiting, as well as sensitivity to light and/or sound, and can interfere with or be aggravated by physical activity.4 Migraine can be classified into different subtypes based on criteria developed by the International Headache Society, with the number of headache days per month differentiating chronic (≥15 days, for >3 months, and migraine headache features ≥8 days per month) and episodic (<15 days) migraine.1,2
Understanding the burden of disease and current treatment patterns is critical for the development of new treatment strategies and improved patient care. The objective of this work was to describe the treatment landscape and clinical and economic burden of migraine in Canada via a literature review.
A search strategy using key terms for migraine was executed in MEDLINE, Embase, and the Cochrane® Library between August 2010 and August 2020 for Canadian populations with migraine. Outcomes included prevalence, clinical or economic measures, and treatments.
We identified some notable trends across the 29 studies of Canadian populations that met the inclusion criteria for our review. Of these, 13 studies reported incidence or prevalence, with a nationally representative survey studies reporting a cumulative incidence of 12,4%(9) and prevalence estimates ranging from 8.3%(2) to 10.2%(5) across the included studies.
Twenty-two of the included studies reported on comorbidities for patients with migraine. Comorbidities were common among migraine patients, especially those with chronic migraine. In one study, 74% of patients with chronic migraine reported having more than 2 comorbidities (vs. 45% with episodic migraine).(19)
Figure 1 Frequency of Comorbidities in Included Studies
Mental health comorbidities, including anxiety, depression and suicidal ideation, were reported across several studies in patients with both chronic and episodic migraine. (10, 23, 26)
Three studies looked at labour force outcomes for patients with migraine, indicating that patient with chronic migraine had poorer work force participation compared to those with episodic migraine.(20, 26, 10) Employment rates were lower in patients with chronic migraine (32.7% to 50.0%) for a full time position than those with episodic migraine (46.0% to 71.8%). (20, 26) One study noted that comorbid mental health and/or psychiatric conditions ere further detrimental to employment outcomes in people with migraine.(10)
Nine studies examined migraine treatment, with 70% of chronic and 80% of episodic migraines treated with acute medications, including 23% with codeine-containing analgesics and 11% with opioids. Most patients (82%) reported previously taking ≥ 3 types of migraine medications.
The proportion of patients taking OTC and prescription medications varied across studies; patients often utilized a variety of medications, and those with chronic migraine tended to have increased medication use compared to those with episodic migraine.(7, 12) Two studies reported that only a small number of patients had utilized preventive medication, and that they were used to a greater extent by those with chronic migraine (22%-40%) compared to those with episodic migraine (9-25%).(19, 20)
Additionally, single studies reported the following:
- Of physicians surveyed in an Ontario Emergency Department, 66% reported that they did not use triptans in treating migraine patients, and among department with headache protocols, fewer than 1% include triptans.(17)
- A retrospective chart audit of patients attending the Medication Assessment Centre, in Saskatchewan found 11% of 36 patients studied were taking opioids for migraine.(21)
- One study reported that of patients referred to a tertiary care pain clinic for migraine, 48% had tried at least 1 triptan and only 31% were actively using a triptan; while 72% were taking an opiate and 27% were taking multiple opiates.(16)
Figure 2 Medication Use as Reported in Included Studies (4, 20)
*Combinations including opiates or barbiturates; **Combinations excluding opiates or barbiturates.
Three studies used Migraine Disability Assessment (MIDAS) scores to assess migraine severity and disability, with chronic migraine patients having being more disabled by their migraine symptoms.
Figure 3 MIDAS Scores as Reported by Included Studies (19, 20, 28)
Note: Grade I: little or no disability; Grade II: mild disability; Grade III: moderate disability; Grade IV: severe disability.
Migraine was associated with increased health care resource use, including a greater number of physician visits compared to controls without headache.(4, 14, 29) Emergency and specialist visits increased by 14% and 5%, respectively, compared to controls, with an average of 24 general physician visits per patient per year, compared to 19 visits on average for controls.
The burden of disease for patients with migraine in Canada is substantial. The medication utilization patterns and unemployment in this population highlight an important gap in existing treatment strategies. Likewise, the higher healthcare costs and reduced quality-of-life demonstrate an unmet need for more effective management. The underutilization of effective treatments and higher rates of unemployment also highlight an important gap in the management of migraine in Canada.
View the full poster here for more information about this research.
1 International Headache Society. The International Classification of Headache Disorders 3rd Edition. 2021. https://ichd-3.org/.
2 Steiner TJ, Birbeck GL, Jensen RH, Katsarava Z, Stovner LJ, Martelletti P. Headache disorders are third cause of disability worldwide. J Headache Pain, 2015;16:58.
3 Steiner TJ, Stovner LJ, Vos T, Jensen R, Katsarava Z. Migraine is first cause of disability in under 50s: will health politicians now take notice? J Headache Pain, 2018;19(1):17.
4 Ramage-Morin PL, Gilmour H. Prevalence of migraine in the Canadian household population. Health Rep, 2014; 25(6):10-6.
5 Worthington I, Pringsheim T, Gawel MJ, Gladstone J, Cooper P, Dilli E, Aube M, Leroux E, Becker WJ; Canadian Headache Society Acute Migraine Treatment Guideline Development Group. Canadian Headache Society Guideline: acute drug therapy for migraine headache. Can J Neurol Sci, 2013;40(5 Suppl 3):S1-S80.
6 Pringsheim T, Davenport W, Mackie G, Worthington I, Aubé M, Christie SN, Gladstone J, Becker WJ; Canadian Headache Society Prophylactic Guidelines Development Group. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci,2012;39(2 Suppl 2):S1-59.