Chart review finds ’significant differences’ in migraine management by race, sex

Migraine diagnoses, treatment and management varied by race and sex among a sample of patients that was “evenly distributed” across the country, according to researchers.

Robert Cowan, MD, FAAN, chief of the division of headache medicine and professor of neurology at Stanford University, presented findings of the cross-sectional chart review at the American Academy of Neurology annual meeting, which is being held virtually.

“In terms of background, it’s certainly been widely observed that disparities exist between various subgroups within the U.S. population, including commonly noted disparities between sex and race,” Cowan said during the presentation. “In this analysis, we looked to determine whether subgroup disparities recognized in general society are in fact reflected in the subpopulations with migraine.”

Cowan and colleagues conducted a cross-sectional chart audit of 1,003 patients (women, n = 710; white, n = 765). Cowan said the practices were “evenly distributed both geographically and by position, academic vs. private practice.” Geographically, 24% of practices were in the Northeast, 30% were in the Southeast, 21% were in the West and 25% were in the Central region of the country; 48% of practices were in urban settings, 46% were in suburban settings and 6% were in rural settings. All patients had recently been prescribed a calcitonin gene-related peptide monoclonal antibody or onabotulinumtoxinA.

The researchers found that women were younger than men at first migraine episode (22.7 years vs. 29.1 years) and diagnosis (26.1 years vs. 32 years). Women were more frequently diagnosed with chronic migraine (41% vs. 24%), anxiety (17% vs. 8%) and depression (27% vs. 21%) than men. Women were also more likely to have Medicaid health insurance (15% vs. 7%); the researchers wrote that having Medicaid was most common among women who indicated their race was African American, Hispanic or Latino, Asian or another race.

The researchers also reported that men were more often diagnosed with low-frequency episodic migraine (28% vs. 16%). More men than women were managed by migraine specialists (52% vs. 36%). The researchers wrote that management by a migraine specialist was most common among men who identified their race as African American, Hispanic or Latino, Asian or another race (56%), particularly when compared with white women (35%).

Two or more previous preventive therapies were not successful in 68% of women. One previous preventive therapy was not successful in 51% of men. Men were more likely than women to have been prescribed Ajovy (fremanezumab; Teva Pharmaceuticals; 22% vs. 17%) or Vyepti (eptinezumab; Lundbeck; 9% vs. 5%).

Compared with white patients, providers’ therapy selection decisions for all other patients were more frequently influenced by patient request (32% vs. 24%), efficacy onset speed expectation (29% vs. 22%), family planning considerations (12% vs. 3%) and nonadherence concerns (11% vs. 5%).

“This study clearly demonstrates there are significant differences among subgroups based on race and sex,” Cowan said. “The roles of culture, comorbidity and economics are likely to be contributing components to these differences; however, we can make no conclusions about the causes and implications of these distinctions and that will require further investigation.”