Certain Social Determinants of Health Contribute to Increased Rates of Migraine vs Headache Diagnosis

Juliana H. VanderPluym, MD

Using a cohort of medically-insured individuals in Arizona, findings from a recently conducted analysis showed specific factors associated with receiving a migraine diagnosis vs a headache diagnosis. Those in the migraine cohort tended to be middle aged, female, White race, non-Hispanic ethnicity, and have English as their primary language.

Presented at the 2023 American Headache Society (AHS) Annual Meeting, held June 15-18, in Austin, Texas, issues within the social determinants of health (SDoH) categories of family unit dynamics (OR, 1.1; 95% CI, 1.06-1.14) and income and social protection (OR, 1.13; 95% CI, 1.08-1.18) were associated with a higher odds of being in the migraine vs headache cohort. In contrast, issues related to housing and basic amenity (OR, 0.68; 95% CI, 0.65-0.71), individual unit dynamics (OR, 0.92; 95% CI, 0.89-0.94), and structural conflict (OR, 0.82; 95% CI, 0.76-0.88) were associated with a lower odds.

Led by Juliana H. VanderPluym, MD, associate professor of neurology in the Division of Headache at Mayo Clinic, the study used claims data from the Arizona Health Care Cost Containment System (AHCCCS), which contained several social risk factors within various categories of SDoH. Demographic characteristics, frequency of comorbidity diagnoses and social risk factors diagnoses, based on ICD 10 codes, were compared between the cohorts using ANOVA F-test or Chi-squared test.

The headache cohort, which included 131,462 individuals, was defined as those with at least 1 inpatient or emergency room claim with a headache diagnosis or at least 2 outpatient claims with headache diagnoses and no claim with a migraine diagnosis and no pharmacy claims for a triptan or ergot. The migraine cohort was defined as: members with at least 1 inpatient or emergency room claim with a migraine diagnosis or at least 1 claim with a migraine diagnosis and at least 1 pharmacy claim for a triptan or ergot or had at least 2 pharmacy claims for a triptan or ergot (n = 76,975).

Using a univariate and multivariable model, findings at the end of the analysis showed that demographic factors of male sex, non-White race, and having a primary language other than English were associated with a lower odds of being in the migraine cohort. Those between the ages of 25 and 54 had an increased odds of being diagnosed with migraine whereas those in the age bracket between 65 and 84 years had lower odds. The presence of comorbidities, which included psychiatric, neurologic, musculoskeletal/pain, sleep, cardiovascular/vascular risk factors, and general comorbidities, were all associated with a higher odds of being in the migraine cohort.

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In terms of SDoH, individuals who had issues with family unit dynamics, specifically “death or disappearance of a family member,” as well as those who reported income and social protection with “low income” as the most frequently reported z code, were at an increased odds of being in the migraine cohort. Problems related to SDoH associated with a lower odds of migraine diagnosis included housing, basic amenities, and the environment with "homelessness” as the most frequently reported Z code. Similarly, lower odds were seen in those with issues related to individuals unit dyanmics with "problems related to unspecific psychosocial circumstances," and structural conflict with "problems related to other legal circumstances."

VanderPluym et al concluded that, "identifying the barriers to providing more detailed diagnoses in the headache cohort will be important and may help bridge gaps in care for this vulnerable population."

Understanding the differences between migraine and headache is critical for treatment decision-making and the development of a treatment plan. Some of the most common headache types include tension headaches, sinus headaches, or cluster headaches, considered the most debilitating. Headaches are one symptom of migraines, and can range in severity and length. Migraines are considered a neurological disease that involve nerve pathways and chemicals, causing a range of symptoms, including nausea, dizziness, increased sensitivity to light, and extreme fatigue.

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REFERENCES
1. VanderPluym J, Zhang N, Reddy S, Prathap N, Schwedt T. Factors associated with receiving a “migraine” diagnosis vs a “headache” diagnosis among adult Arizona Medicaid recipients: demographics, comorbidity, and problems relating to social determinants of health. Presented at: 2023 AHS Annual Meeting; June 15-18; Austin, TX. Abstract OR-06.