Access to Acute Treatments for Migraine Can Reduce Costs for Employers, Health Care System Landing Page

Improving access to optimal treatments for acute episodes of migraine could prevent chronification and reduce costs to employers and the health care system, data suggests.

Migraine affects 47 million Americans and more than 1 billion people globally, writes Olivia Begasse de Dhaem, MD, neurologist and headache specialist, Stamford Health, in an article published in Harvard Business Review.¹ Migraines can last between 4 to 72 hours, and symptoms can include nausea, throbbing or pulsing pain, as well as sensitivity to light and sound.²

“Migraines can be severely debilitating and are considered one of the main causes of disability worldwide,” according to the Centers for Disease Control and Prevention (CDC).³ “In one study among patients with migraines in the United States, more than half reported severe impairment in activity, the need for bed rest, and/or reduced work or school productivity due to migraines.”

Lost work and school productivity due to migraine has resulted in total indirect costs of $19.3 billion annually in the United States as of 2019, largely due to absenteeism. Presenteeism, in which an employee attends work but is not as productive as possible, could contribute additional indirect costs.⁴

Episodic vs Chronic

A migraine diagnosis is considered episodic if a patient reports fewer than 15 headache days per month for 3 months, or chronic if the number reaches or exceeds 15 headache days.⁴ In the United States, Europe, and Australia, annual medical costs for chronic migraine, including treatment, diagnostic tests, and hospitalizations, are 3 times higher on average compared to costs of episodic migraine.⁵

Episodic migraine diagnoses can progress to chronic status, and risk factors for chronification include high episodic attack frequency and incorrect use of acute medication.⁵ Research suggests fewer than 10% of patients in most of the top 10 countries reporting frequent migraine received adequate acute treatment, and an even smaller number of eligible patients had access to medication for migraine.⁶

A Case for Acute Therapy

According to the CDC,³ 36% of adolescents and young adults treated for migraine in the emergency department were prescribed opioids. Opioid therapy for migraine has been linked to higher risk of readmission and longer lengths of stay—both of which are associated with increased health care costs.

A systematic review and meta-analysis published⁷ in the Journal of the American Medical Association showed evidence supports the efficacy and safety of other acute treatment options over opioids. Acute therapy for migraine can include nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, calcitonin gene-related peptide receptor antagonists, 5-HT1F receptor agonists, dihydroergotamine, acetaminophen, and remote electrical neuromodulation.

Juliana H VanderPluym, MD, neurologist, Mayo Clinic, and coauthors “found high and moderate strengths of evidence in support of triptans and NSAIDs, respectively, and these drug classes should remain as the primary choice for the acute treatment of migraine in patients who do not have contraindications.”⁷

Intranasal administration of acute treatments has been developed to overcome oral route limitations and increase how quickly the medication is absorbed.⁸ Nasal triptans and dihydroergotamine are indicated for patients with acute migraine.

Some nasal sprays are indicated for children aged 12 years and older and can be useful for those experiencing severe symptoms rather than slower-onset, milder symptoms. The American Migraine Foundation reports nasal triptan sprays can take effect in 15 minutes, while oral treatments provide relief in approximately 30 minutes.⁹

“Barriers to good outcomes in migraine include the lack of appropriate medical consultation, failure to receive an accurate diagnosis, not being offered a regimen with acute and preventive pharmacologic treatments (if indicated), and not avoiding medication overuse,” writes Dawn C Buse, PhD, Department of Neurology, Albert Einstein College of Medicine, and coauthors.¹⁰

To enhance care and outcomes, researchers recommended improving guideline-based treatment delivery and increasing consultation rates to ensure patients with migraine receive a diagnosis.¹⁰

References:

1. de Dhaem OB. Migraines are a serious problem. Employers can help. Harvard Business Review. February 24, 2021. Accessed May 19, 2022. https://hbr.org/2021/02/migraines-are-a-serious-problem-employers-can-help
2. Mayo Clinic staff. Migraine. Mayo Clinic. July 2, 2021. Accessed May 19, 2022. https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201
3. Centers for Disease Control and Prevention. Acute migraine. Reviewed January 28, 2022. Accessed May 19, 2022. https://www.cdc.gov/acute-pain/migraine/index.html
4. Yucel A, Thach A, Kumar S, et al. Estimating the economic burden of migraine on US employers. Am J Manag Care. 2020;26(12):e403-e408. doi:10.37765/ajmc.2020.88547
5. Mungoven TJ, Henderson LA, Meylakh N. Chronic migraine pathophysiology and treatment: A review of current perspectives. Front Pain Res (Lausanne). 2021;2:705276. doi:10.3389/fpain.2021.705276
6. 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):17. doi:10.1186/s10194-018-0846-2
7. VanderPluym JH, Singh RBH, Urtecho M, et al. Acute treatments for episodic migraine in adults: A systematic review and meta-analysis. JAMA. 2021;325(23):2357-2369. doi:10.1001/jama.2021.7939
8. Assadpour S, Shiran MR, Asadi P, Akhtari J, Sahebkar A. Harnessing intranasal delivery systems of sumatriptan for the treatment of migraine. Biomed Res Int. Published online January 15, 2022. doi:10.1155/2022/3692065
9. American Migraine Foundation. Do nasal sprays for migraine work? Plus, which ones to try. October 28, 2021. Accessed May 19, 2022. https://americanmigrainefoundation.org/resource-library/migraine-nasal-sprays/
10. Buse DC, Armand CE, Charleston 4th L, et al. Barriers to care in episodic and chronic migraine: Results from the Chronic Migraine Epidemiology and Outcomes Study. Headache. 2021;61(4):628-641. doi:10.1111/head.14103