Barriers to Chronic Migraine Care: Results of the CaMEO (Chronic Migraine Epidemiology & Outcomes) Study (I9-1.004)

OBJECTIVE: To describe respondent self-reported headache diagnosis rates and healthcare consultation patterns among individuals with chronic migraine (CM). BACKGROUND: CaMEO is a prospective, web-based cohort study to characterize migraine clinical course, family burden, barriers to care, endophenotypes, and comorbidities among those with CM and episodic migraine. DESIGN/METHODS: In September 2012, individuals with migraine were identified from a web-based panel using quota sampling to ensure a US-demographically representative sample. This analysis includes data from the “Barriers to Care Module” for only participants with CM ( ICHD-2 migraine diagnosis and 蠅15 headache days/month for past 3 months). Outcomes include rates and types of healthcare professionals (HCPs) consulted for headache, and self-reported headache diagnoses. Participants could report multiple types of HCPs and headache diagnoses. RESULTS: 1,476 respondents were classified with CM. Among those with CM: migraine, CM, or related diagnoses were made more frequently by “Headache Specialists” than other HCP types, although rates of consultation with “Headache Specialists” were low (200/1,476 [13.6%]), as were rates of CM/transformed migraine (TM) diagnoses (range by HCP, 11.0%-36.0%). Most respondents did not receive a CM diagnosis, even among those consulting “Headache Specialists” (64.0%). Those who were currently seeing only a “Nonprescribing HCP” were the least likely to have ever received a diagnosis of migraine (54.5% vs 83.0% seeing “Headache Specialists”), CM/TM (11.0% vs 36.0% seeing “Headache Specialists”), or CM/TM/chronic daily headache (20.4% vs 45.5% seeing “Headache Specialists”). More CM respondents were currently seeking care from a “Nonprescribing HCP” (n=319) than a “Headache Specialist” (n=200). CONCLUSIONS: These findings suggest that rates of headache subtype diagnosis and consultation for headache are low among individuals with CM. This is a barrier to optimal care, as diagnosis is necessary to optimize treatment, which may include diagnosis-specific treatments. Study Supported by: Allergan, Inc., Irvine, CA. Disclosure: Dr. Buse has received personal compensation for activities with Allergan Inc., and Zogenix. Dr. Buse has received research support from Allergan Inc., Merck & Co. Inc., and Zogenix. Dr Lipton has received personal compensation for activities with Allergan, American Headache Society, Autonomic Technologies, Boston Scientific, Bristol-Myers Squibb Company, Cognimed, Colucid, Eli Lilly & Company, eNeura Therapeutics, GlaxoSmithKline, Inc., MAP Pharmaceuticals, Merck, Nautilus Neuroscience, Novartis, NuPathe, Vedanta, and Zogenix. Dr. Lipton holds stock and/or stock options in eNeura Therapeutics. Dr. Reed has received research support from Allergan Inc., ENDO, Merck & Co. Inc., GlaxoSmithKline Inc., MAP Pharmaceuticals, Novartis, NuPathe, CoLucid, and the National Headache Foundation. Dr. Serrano has received research support from Allergan, Inc. Dr. Fanning has received personal compensation for activities with Vendanta as an employee. Dr. Fanning has received research support from Allergan Inc., Colucid, Endo, GlaxoSmithKline Pharmaceuticals Inc., MAP Pharmaceuticals, Merck & Co. Inc., NuPathe, Novartis, and Ortho-McNeil. Dr. Manack has received personal compensation for activities with Allergan Inc.