Migraine Is More Than a Headache.
It Is a Complex, Serious, and Debilitating Neurological Disease1-3

Migraine is ~ 3 times more common in women than men in the United States4

Migraine most commonly occurs between ages 30 to 49, impacting individuals during the formative and most productive periods of their lives4

ONE-YEAR PREVALENCE OF MIGRAINE IN THE US POPULATION BY AGE AND SEX4

AMPP* Data From 2004, Adjusted for Demographics

A SINGLE MIGRAINE ATTACK CAN LAST UP TO 72 HOURS, BUT THE PHYSICAL EFFECT OF A SINGLE MIGRAINE CYCLE CAN IMPACT PATIENTS FOR UP TO 7 DAYS5-7

> 90%
of people with migraine are impaired during a migraine attack4,‡
> 50%
of people with migraine reported severe impairment or required bed rest from their headaches4,‡
25%
of people with migraine missed at least 1 day of work or school in the previous 3 months4

Migraine Carries Substantial
Costs Nationwide1,2

The annual direct cost of migraine in the United States1,2,*
Average annual disability costs of migraine patients eligible for short-term disability versus those without migraine can be up to3
The annual indirect cost in the United States caused by migraine2,4,†,‡
~$17.8 Billion1,2
3x MORE3
~$19.3 Billion2,4

Care Gaps: Migraine Is Underdiagnosed and Undertreated1

Preventive therapy* is effective for some patients. For example, studies indicate that ~ 45% of patients receiving oral preventive therapy will
experience a reduction in the mean monthly frequency of migraine attacks by ≥ 50%.2,3 Even though there is a potential
benefit in using preventive therapy, data suggest that it is underutilized.1

of migraine patients who qualify for preventive therapy do not receive it4
of migraine patients who received oral preventive treatment, were nonadherent after 6 months5
of patients with migraine who failed at least 1 preventive treatment had at least 1 migraine-related emergency department (ED) visit a year6,†

PREVENTIVE THERAPY IS USED TO DECREASE THE FREQUENCY, DURATION, AND SEVERITY OF ATTACKS7

Additional benefits may include improved response to acute treatments and patient's ability to function, as well as reduction of disability7

AHS Consensus Statement recommends considering preventive migraine therapies for patients with frequent headaches, who are overusing acute medication, or experience significant disability from migraine2,7

  • AHS guidance recommends caution with the use of certain acute therapies, including opioids7

Who Are the Quality Care Stakeholders in Migraine Health?

CMS QUALITY PAYMENT PROGRAM/MIPS (2020)
Overuse of Imaging for the Evaluation of Primary Headache1
Quality of Life Assessment for Patients With Primary Headache Disorders2

A Case of Improved Migraine Care—
St. John’s Mercy Medical Group in St. Louis, MO1

Situation
Task
Actions
Results
The Situation
A group practice within a metropolitan area
With 120 primary care clinicians
Providing care for more than 200,000 patients
Problem

Effective self-management of migraine requires patient understanding of migraine and its management, and benefits of educational programs have been reported. However, most of these programs require referral to headache specialty clinics, and access to these services is limited in many communities, thus requiring patients to rely on their primary care providers for migraine care education and counseling.

The Tasks

St. John’s Mercy Medical Group developed the Mercy Migraine Management Program (MMMP) to provide a migraine educational program to clinicians in a provider-group setting and improve outcomes for patients with migraine/headache

Increase Provider Knowledge

Focus on the ability of providers to equip patients with tools for daily self-management of migraine

Improve Outcomes, Including Quality of Life

Reducing headache days while improving the quality of life, self-efficacy in managing headaches, and satisfaction with care of patients with migraine/headache

Support Appropriate Resource Utilization

Ensure appropriate utilization of medications and reduce the number of headache-related emergency department visits

The Actions
The actions necessary to implement and evaluate the MMMP required collaborative participation by both providers and patients
Structured Education for Providers
  • One 2-hour continuing medical education program, with printed educational materials
  • Key topics included (1) impact recognition diagnosis of headache,* (2) the benefits of early intervention with abortive therapies, especially with migraine-specific medications, (3) effective preventive treatments, and (4) nonpharmacological management
Personalized, Detailed Plan of Care
  • Upon diagnosis confirmation, eligible patients completed a baseline questionnaire and received self-management educational materials following the primary care
  • During the visit, the clinician made medication or other treatment recommendations based on the knowledge obtained from the educational seminar and print materials
Long-term Follow-up
  • Patients were surveyed at 3, 6, and 12 months post visit
  • Headache days, quality of life, worry about headaches, self-efficacy for controlling headaches, satisfaction with headache care, and emergency department visits were measured
The Results
Fewer
Headache Days
  • At least a 50% reduction in headache frequency was reported by 34% (n = 77/228) of patients at 3 months, 38% (n = 86/228) at 6 months, and 46% (n = 106/228) at 12 months
Improved
Quality of Life
  • Significant improvements on the HIT-6 and all 3 subscales of the MSQ measure
Fewer
Emergency
Department
Visits
  • Fewer patients went to the emergency department at each follow-up interval compared with baseline*
Reduced Worry
  • The percentage of participants with High Worry decreased significantly 3, 6, and 12 months after the intervention visit
Higher Self-Efficacy
  • The percentage of participants with High Self-Efficacy was significantly higher 12 months after the intervention visit
Improved
Satisfaction
With Care
  • 78% of patients reported satisfaction with headache care at 12 months, compared with 29% at baseline