TABLE 2.
Demographic features, consultation, diagnosis, and treatment use; stratified by monthly headache days OVERCOME (US) 2018 migraine cohort
| Total | Monthly headache days | Comparison between monthly headache day groups OR/RR/beta (95% CI) q | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 0–3 | 4–7 | 8–14 | ≥15 | ||||||||||
| (N = 21,143) | (N = 12,299) | (N = 4070) | (N = 2291) | (N = 2483) | 4–7 vs. 0–3 | 8–14 vs. 0–3 | ≥15 vs. 0–3 | ||||||
| N/mean | %/SD/range | N/mean | %/SD/range | N/mean | %/SD/range | N/mean | %/SD/range | N/mean | %/SD/range | ||||
| Demographics | |||||||||||||
| Age, years | 42.2 | 15.0 | 42.3 | 15.3 | 41.5 | 14.5 | 41.4 | 14.4 | 43.5 | 14.8 | Beta = −0.83 (−1.36, −0.30) | Beta = −0.93 (−1.60, −0.26) | Beta = 1.20 (0.55, 1.85) |
| Female | 15,697 | 74.2% | 8807 | 71.6% | 3101 | 76.2% | 1786 | 78.0% | 2003 | 80.7% | OR = 1.27 (1.17, 1.38) | OR = 1.40 (1.26, 1.56) | OR = 1.65 (1.49, 1.84) |
| Marital status a | |||||||||||||
| Married | 9288 | 43.9% | 5505 | 44.8% | 1757 | 43.2% | 958 | 41.8% | 1068 | 43.0% | OR = 0.972 (0.91, 1.04) | OR = 1.00 (0.92, 1.10) | OR = 1.04 (0.95, 1.13) |
| Living with partner | 2577 | 12.2% | 1399 | 11.4% | 501 | 12.3% | 332 | 14.5% | 345 | 13.9% | |||
| Single | 5901 | 27.9% | 3545 | 28.8% | 1164 | 28.6% | 611 | 26.7% | 581 | 23.4% | |||
| Divorced | 2234 | 10.6% | 1232 | 10.0% | 437 | 10.7% | 254 | 11.1% | 311 | 12.5% | |||
| Widowed | 619 | 2.9% | 339 | 2.8% | 109 | 2.7% | 70 | 3.1% | 101 | 4.1% | |||
| Separated | 450 | 2.1% | 234 | 1.9% | 90 | 2.2% | 61 | 2.7% | 65 | 2.6% | |||
| Prefer not to answer b | 74 | 0.3% | 45 | 0.4% | 12 | 0.3% | 5 | 0.2% | 12 | 0.5% | |||
| Household income c | |||||||||||||
| Less than $25,000 | 4575 | 21.6% | 2535 | 20.6% | 889 | 21.8% | 514 | 22.4% | 637 | 25.7% | |||
| $25,000 to $49,999 | 5703 | 27.0% | 3199 | 26.0% | 1111 | 27.3% | 667 | 29.1% | 726 | 29.2% | |||
| $50,000 to $74, 999 | 4155 | 19.7% | 2446 | 19.9% | 817 | 20.1% | 433 | 18.9% | 459 | 18.5% | OR = 0.92 (0.86, 0.99) | OR = 0.83 (0.76, 0.91) | OR = 0.72 (0.66, 0.79) |
| $75,000 to $99,999 | 2637 | 12.5% | 1589 | 12.9% | 476 | 11.7% | 276 | 12.0% | 296 | 11.9% | |||
| $100,000 or over | 3351 | 15.8% | 2063 | 16.8% | 663 | 16.3% | 337 | 14.7% | 288 | 11.6% | |||
| Prefer not to answer b | 722 | 3.4% | 467 | 3.8% | 114 | 2.8% | 64 | 2.8% | 77 | 3.1% | |||
| Education d | |||||||||||||
| Less than high school degree | 1304 | 6.2% | 742 | 6.0% | 260 | 6.4% | 141 | 6.2% | 161 | 6.5% | |||
| High school degree and less than college degree | 12,192 | 57.7% | 6868 | 55.8% | 2385 | 58.6% | 1375 | 60.0% | 1564 | 63.0% | |||
| College degree or more | 7599 | 35.9% | 4661 | 37.9% | 1417 | 34.8% | 766 | 33.4% | 755 | 30.4% | OR = 0.88 (0.81, 0.94) | OR = 0.83 (0.75, 0.91) | OR = 0.72 (0.65, 0.78) |
| Prefer not to answer b | 48 | 0.2% | 28 | 0.2% | 8 | 0.2% | 9 | 0.4% | 3 | 0.1% | |||
| Employment status e | |||||||||||||
| Employed full time | 9313 | 44.0% | 5645 | 45.9% | 1847 | 45.4% | 960 | 41.9% | 861 | 34.7% | OR = 0.98 (0.91, 1.05) | OR = 0.85 (0.78, 0.93) | OR = 0.63 (0.57, 0.68) |
| Employed part time | 2744 | 13.0% | 1670 | 13.6% | 515 | 12.7% | 275 | 12.0% | 284 | 11.4% | |||
| Retired | 2489 | 11.8% | 1525 | 12.4% | 383 | 9.4% | 239 | 10.4% | 342 | 13.8% | |||
| Homemaker | 2271 | 10.7% | 1193 | 9.7% | 481 | 11.8% | 276 | 12.0% | 321 | 12.9% | |||
| Long‐term or short‐term disability | 1443 | 6.8% | 614 | 5.0% | 295 | 7.2% | 210 | 9.2% | 324 | 13.0% | |||
| Not employed and looking for work | 1164 | 5.5% | 668 | 5.4% | 212 | 5.2% | 123 | 5.4% | 161 | 6.5% | |||
| Student | 1070 | 5.1% | 642 | 5.2% | 213 | 5.2% | 119 | 5.2% | 96 | 3.9% | |||
| Not employed and not looking for work | 531 | 2.5% | 277 | 2.3% | 104 | 2.6% | 71 | 3.1% | 79 | 3.2% | |||
| Prefer not to answer b | 118 | 0.6% | 65 | 0.5% | 20 | 0.5% | 18 | 0.8% | 15 | 0.6% | |||
| Hispanic ethnicity | |||||||||||||
| Yes | 2152 | 10.2% | 1314 | 10.7% | 420 | 10.3% | 207 | 9.0% | 211 | 8.5% | OR = 0.96 (0.86, 1.08) | OR = 0.83 (0.71, 0.97) | OR = 0.78 (0.67, 0.90) |
| No | 18,385 | 87.0% | 10,640 | 86.5% | 3527 | 86.7% | 2012 | 87.8% | 2206 | 88.8% | |||
| Prefer not to answer b | 606 | 2.9% | 345 | 2.8% | 123 | 3.0% | 72 | 3.1% | 66 | 2.7% | |||
| Race f | |||||||||||||
| White or Caucasian only | 16,758 | 79.3% | 9439 | 76.7% | 3339 | 82.0% | 1905 | 83.2% | 2075 | 83.6% | OR = 1.39 (1.27, 1.52) | OR =1.50 (1.33, 1.68) | OR = 1.55 (1.38, 1.74) |
| Black or African American only | 1824 | 8.6% | 1255 | 10.2% | 288 | 7.1% | 155 | 6.8% | 126 | 5.1% | |||
| Asian or Asian American only | 681 | 3.2% | 502 | 4.1% | 108 | 2.7% | 37 | 1.6% | 34 | 1.4% | |||
| American Indian or Alaska native only | 225 | 1.1% | 125 | 1.0% | 35 | 0.9% | 32 | 1.4% | 33 | 1.3% | |||
| Other only g | 612 | 2.9% | 401 | 3.3% | 106 | 2.6% | 49 | 2.1% | 56 | 2.3% | |||
| Two or more races | 869 | 4.1% | 466 | 3.8% | 163 | 4.0% | 98 | 4.3% | 142 | 5.7% | |||
| Prefer not to answer b | 174 | 0.8% | 111 | 0.9% | 31 | 0.8% | 15 | 0.7% | 17 | 0.7% | |||
| Consultation/diagnosis | |||||||||||||
| Sought care for headache/migraine (LIFETIME) | 16,686 | 78.9% | 9020 | 73.3% | 3442 | 84.6% | 1947 | 85.0% | 2277 | 91.7% | OR = 1.99 (1.81, 2.19) | OR = 2.06 (1.82, 2.32) | OR = 4.02 (3.46, 4.66) |
| No. healthcare visits total in the last 12 months | RR = 1.36 (1.34, 1.38) | RR = 1.69 (1.67, 1.71) | RR = 2.20 (2.17, 2.23) | ||||||||||
| Mean (SD) | 9.2 | (17.6) | 7.2 | (14.3) | 9.7 | (14.9) | 12.1 | (20.5) | 15.7 | (28.2) | |||
| Median (range) | 5 | (0–680) | 4 | (0–533) | 6 | (0–344) | 7 | (0–343) | 9 | (0–680) | |||
| No. healthcare visits for headache/migraine in the last 12 months h | RR = 1.81 (1.77, 1.85) | RR = 2.45 (2.39, 2.51) | RR = 3.62 (3.55, 3.70) | ||||||||||
| Mean (SD) | 2.9 | (7.8) | 1.8 | (5.4) | 3.2 | (7.5) | 4.4 | (10.6) | 6.5 | (12.8) | |||
| Median (range) | 0 | (0–273) | 0 | (0–273) | 1 | (0–184) | 1 | (0–230) | 2 | (0–220) | |||
| Age at migraine diagnosis, mean (SD) i , j | 23.7 | 11.8 | 23.9 | 11.8 | 23.4 | 11.4 | 23.7 | 12.2 | 23.8 | 12.0 | Beta = −0.55 (−1.11, 0.02) | Beta = −0.24 (−0.95, 0.46) | Beta = −0.14 (−0.79, 0.52) |
| Years between migraine onset and migraine diagnosis, mean (SD) j | 3.3 | 6.5 | 3.2 | 6.5 | 3.5 | 6.5 | 3.4 | 6.6 | 3.6 | 6.6 | Beta = 0.31 (−0.03, 0.64) | Beta = 0.27 (−0.15, 0.68) | Beta = 0.40 (0.01, 0.79) |
| Treatment patterns | |||||||||||||
| Migraine medication use (LIFETIME) | |||||||||||||
| Acute treatment, prescription/OTC k , l | 20,520 | 97.1% | 11,814 | 96.1% | 4002 | 98.3% | 2258 | 98.6% | 2446 | 98.5% | OR = 2.42 (1.87, 3.12) | OR = 2.81 (1.97, 4.01) | OR = 2.71 (1.94, 3.80) |
| Acute prescription | 16,239 | 76.8% | 8885 | 72.2% | 3305 | 81.2% | 1898 | 82.9% | 2151 | 86.6% | OR = 1.66 (1.52, 1.81) | OR = 1.86 (1.65, 2.08) | OR = 2.49 (2.20, 2.81) |
| Triptan | 7392 | 35.0% | 3658 | 29.7% | 1606 | 39.5% | 939 | 41.0% | 1189 | 47.9% | OR = 1.54 (1.43, 1.66) | OR = 1.64 (1.50, 1.80) | OR = 2.17 (1.99, 2.37) |
| Opioid | 10,090 | 47.7% | 5138 | 41.8% | 2137 | 52.5% | 1277 | 55.7% | 1538 | 61.9% | OR = 1.54 (1.44, 1.66) | OR = 1.76 (1.60, 1.92) | OR = 2.27 (2.08, 2.48) |
| Preventive use m | 5525 | 26.1% | 2481 | 20.2% | 1166 | 28.7% | 760 | 33.2% | 1118 | 45.0% | OR = 1.59 (1047,1.72) | OR = 1.96 (1.78,2.17) | OR = 3.24 (2.96,3.55) |
| Neurostimulation n | 488 | 2.3% | 187 | 1.5% | 102 | 2.5% | 70 | 3.1% | 129 | 5.2% | OR = 1.67 (1.31, 2.13) | OR = 2.04 (1.55, 2.70) | OR = 3.55 (2.82, 4.46) |
| Biobehavioral o | 3879 | 18.4% | 1726 | 14.0% | 901 | 22.1% | 558 | 24.4% | 694 | 28.0% | OR = 1.74 (1.59, 1.91) | OR = 1.97 (1.77, 2.20) | OR = 2.38 (2.15, 2.63) |
| Migraine medication use (CURRENT) p | |||||||||||||
| Acute treatment, prescription/OTC k | 19,915 | 94.2% | 11,384 | 92.6% | 3927 | 96.5% | 2212 | 96.6% | 2392 | 96.3% | OR = 2.21 (1.84, 2.64) | OR = 2.25 (1.78, 2.85) | OR = 2.11 (1.70, 2.63) |
| OTC | 17,304 | 81.8% | 9921 | 80.7% | 3399 | 83.5% | 1941 | 84.7% | 2043 | 82.3% | OR = 1.21 (1.11, 1.33) | OR = 1.33 (1.18, 1.50) | OR = 1.11 (1.00, 1.25) |
| Acute prescription | 8457 | 40.0% | 4140 | 33.7% | 1841 | 45.2% | 1106 | 48.3% | 1370 | 55.2% | OR = 1.63 (1.51, 1.75) | OR = 1.84 (1.68, 2.01) | OR = 2.43 (2.22, 2.65) |
| Triptan | 4792 | 22.7% | 2261 | 18.4% | 1096 | 26.9% | 657 | 28.7% | 778 | 31.3% | OR = 1.64 (1.51, 1.78) | OR = 1.79 (1.61, 1.98) | OR = 2.03 (1.84, 2.23) |
| Opioid | 4033 | 19.1% | 1888 | 15.4% | 879 | 21.6% | 557 | 24.3% | 709 | 28.6% | OR = 1.52 (1.39, 1.66) | OR = 1.77 (1.59, 1.97) | OR = 2.20 (1.99, 2.44) |
| Preventive m | 3555 | 16.8% | 1624 | 13.2% | 747 | 18.4% | 467 | 20.4% | 717 | 28.9% | OR = 1.48 (1.34, 1.63) | OR = 1.68 (1.50, 1.89) | OR = 2.67 (2.41, 2.95) |
| Neurostimulation n | 250 | 1.2% | 103 | 0.8% | 50 | 1.2% | 36 | 1.6% | 61 | 2.5% | OR = 1.47 (1.05, 2.07) | OR = 1.89 (1.29, 2.77) | OR = 2.98 (2.17, 4.11) |
| Biobehavioral o | 2994 | 10.8% | 1292 | 10.5% | 712 | 17.5% | 441 | 19.2% | 549 | 22.1% | OR = 1.81 (1.64, 2.00) | OR = 2.03 (1.80, 2.29) | OR = 2.42 (2.16, 2.70) |
Abbreviations: CI, confidence interval; OR, odds ratio; OTC, over‐the‐counter; OVERCOME, ObserVational survey of the Epidemiology, tReatment and Care of MigrainE; RR, rate ratio; SD, standard deviation.
Marital status was dichotomized as married or living with a partner versus single, divorced, widowed, and separated.
Survey questions with responses “Prefer not to answer” were excluded from this analysis.
Household income was dichotomized as greater or equal to $50,000 versus less than $50,000.
Education was dichotomized as having a college degree versus no college degree.
Employment status was dichotomized as employed full time versus employed part time, retired, homemaker, long‐term or short‐term disability, not employed and looking for work, student, and not employed and not looking for work.
Race was dichotomized as White or Caucasian only versus Black or African American only, Asian or Asian American only, American Indian or Alaska native only, Other only, and two or more races.
Includes native Hawaiian/Pacific Islander only or other race only.
N = 106 (1%) respondents answered “don’t know” on headache/migraine healthcare visits.
Maximum age of respondents was 95 years; however due to study design and data privacy‐related issues, all n = 21 respondents 85 years and older were included in the age group 85 years.
Among those with a migraine diagnosis.
Acute medications, prescription and OTC, used for the acute treatment of migraine included specific names (brand/generic) of triptans, opioids, barbiturates, ergot alkaloids, nonsteroidal anti‐inflammatory drugs (NSAIDs), and simple/combination analgesics.
OTC reflects current use.
Preventive medications used for the preventive treatment of migraine included specific names (brand/generic) of antidepressants, antiseizure drugs, antihypertensive drugs, botulinum neurotoxins, and calcitonin gene‐related peptide (CGRP) monoclonal antibodies available at the time of the survey.
Neurostimulation involved non‐surgical external nerve stimulator devices.
Biobehavioral treatments involved those treatments used specifically for migraine prevention.
“Current” defined as “currently using or typically keep on hand” for acute medications and “last 3 months” for preventive medications.
Models assessed the effect of each monthly headache day group 4–7, 8–14, and ≥15 versus 0–3 monthly headache days on each dichotomized variable (predicted event italicized). Logistic regression models were used to assess odds ratios (ORs) for binary outcomes, linear regression models were used and the beta was reported for continuous outcomes with a normal distribution, and Poisson regression models were used and rate ratios (RRs) were approximated and presented for continuous variables with a Poisson distribution. All models were unadjusted, and 95% CIs reported. Parameter estimates (OR, beta, or RR) were bolded to indicate statistical significance.