Real‐world diagnosis and treatment of individuals with migraine in the United States: The Migraine Insights in Diagnosis and Treatment ( MIND ) study

OBJECTIVE: The objective of this study was to describe the real-world diagnosis and treatment patterns of individuals newly diagnosed with migraine in the United States (US). BACKGROUND: Over 10% of adults in the US are living with migraine. Recent data from large, population-based studies on the diagnosis and treatment of migraine among individuals in the US who are newly diagnosed with migraine are lacking. METHODS: The Migraine Insights in Diagnosis and Treatment (MIND) study is a retrospective cohort study conducted using the Optum® Market Clarity database. The study included individuals with a first migraine diagnosis between July 1, 2018, and June 30, 2021 (index date), who were ≥18 years old on the index date, had ≥12 months of pre-index and ≥36 months of post-index continuous claims enrollment, and no diagnosis of migraine or use of migraine-specific medications in the pre-index period. Outcomes included index migraine diagnosis (e.g., migraine type, setting of diagnosis, specialty of the diagnosing healthcare provider [HCP]), and use of medications to treat migraine (e.g., medications indicated for acute treatment, prevention, or both; other analgesics). Medications were further subcategorized into migraine-specific acute (triptans, gepants, ergots, and ditans) and preventive (gepants and calcitonin gene-related peptide [CGRP] targeted monoclonal antibodies [mAbs]) medications. All analyses were descriptive in nature. RESULTS: The study database included 911,128 individuals newly diagnosed with migraine, of whom 154,353 met all study eligibility criteria. Mean age was 46.1 years, 81.1% were female, and 66.3% were commercially insured. Common comorbidities included anxiety (40.5%), depression (28.2%), and sleep disorders (26.9%). The most common HCP specialty for the index migraine diagnosis was primary care (47.0%), followed by neurology (18.0%), and other (15.3%); diagnosis most often occurred in outpatient (89.5%) settings, followed by inpatient (7.7%), and emergency department (2.8%). Only 16.2% of individuals had a diagnostic test within 30 days before or after their index migraine diagnosis. A total of 111,345 (72.1%) individuals filled a prescription for a migraine medication in the 3 years after their index diagnosis, including 94,198 (61.0%) who received a medication for acute treatment and 62,596 (40.6%) who received a medication for prevention. The most commonly used acute migraine medication types prescribed first were NSAIDs (62.8%) and triptans (35.0%), while for prevention, it was beta blockers (23.2%) and anticonvulsants (21.6%). Migraine-specific preventive medications, CGRP-targeted mAbs (8.1%) and gepants (1.2%), were used first less frequently. A total of 71,199 (46.1%) individuals filled a prescription for an opioid in the 3 years after the index diagnosis of migraine, while 19,359 (12.5%) filled a prescription for butalbital. CONCLUSION: This study highlights the frequent utilization of medications that are not migraine-specific, both for acute treatment and preventive management of migraine. Increased efforts towards education for the optimal management of migraine should be implemented.