Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Treatment Patterns Among Patients with Migraine

Among US adult patients treated for migraine, characteristics including patient-functioning measures and comorbidities are predictive of high vs medium-costs, and medium vs low-costs, a new study found. Data from the Household Component of Medical Expenditure Panel Survey (MEPS-HC, 2008-2012), a nationally representative survey of noninstitutionalized civilians in the US, were analyzed. Key inclusion criteria were migraine diagnosis and prescribed treatment for migraine. Patients were categorized into high, low, and median cost subgroups per migraine-specific total costs. Researchers found:

  • Within the treated migraine cohort (n=1,735), the mean age was 39 years, 80% female, and the majority were in the medium-cost subgroup.
  • Significant predictors of high vs medium-costs included patient-functioning measures and comorbidities.
  • Preventive eligibility was a predictor of being in the higher cost subgroup.
  • Preventive treatment that improve functioning and reduce acute medication use have the potential to reduce migraine-specific costs.


Ford JH, Ye W, Nichols RM, Foster SA, Nelson DR. Treatment patterns and predictors of costs among patients with migraine: Evidence from the United States Medical Expenditure Panel Survey. [Published online ahead of print April 12, 2019]. J Med Econ. doi:10.1080/13696998.2019.1607358.


This large data-based study found that higher-cost migraine patients had significantly poorer quality of life than medium- or low-cost patients by a variety of measures. Even the difference between medium-cost and low-cost migraine patients could be predicted by comorbidities including anxiety. Migraine preventive and acute medication use predicted higher costs, and the investigators noted studies that acute medication overuse also predicted greater costs. They also felt that higher costs were related to higher headache frequency, as chronic migraine patients incur higher costs than episodic migraine patients. The investigators speculated that The utilization of safe, tolerable and effective preventive treatments that reduce acute medication use and improve patients’ functioning may reduce migraine-specific direct and indirect costs.” This is of great importance with the advent of the anti-calcitonin gene-related peptide (CGRP) and anti-CGRP receptor monoclonal antibodies, proven to convert patients from chronic to episodic migraine, from acute medication overuse to no overuse, and to improve quality of life by Patient Reported Outcome measures. —Stewart J. Tepper, MD, FAHS, Professor of Neurology, Geisel School of Medicine at Dartmouth, Director, Dartmouth Headache Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH