Preventing migraines cuts pain and costs

Disease management guidelines have long recommended a daily drug regimen to reduce patient discomfort, but a new study concludes it reduces health care expenditures, too.

By Victoria Stagg Elliott, amednews staff. March 24/31, 2003.

The use of medication to prevent migraines by patients who regularly use acute drugs to control pain could save hundreds of dollars per year per patient and significantly reduce the number of physician or emergency department visits, according to a study published in the March Headache: The Journal of Head and Face Pain.

Researchers at Thomas Jefferson University in Philadelphia retroactively analyzed medication use and health system utilization by migraine patients who were part of a large claims database.

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They compared patients' utilization for the six months before the addition of preventive medication, when they were only on acute medication, to that of the year following the addition of the preventive drugs.

"From a cost point of view, preventive therapy is actually a cost benefit," said Stephen D. Silberstein, MD, lead author of the paper and professor of neurology at Thomas Jefferson. "Patients don't need unnecessary diagnostic tests or doctors visits or emergency department visits."

Previous studies had only shown reductions in patient discomfort and medication overuse, which can lead to rebound headaches. This was the first to look at the cost impact of prevention strategies as recommended by the U.S. Headache Consortium.

Experts say, however, that there are significant barriers to getting more patients on preventive care.

They talk about physician hesitancy because the initial prescription of such drugs can take more time than just dealing with the acute situation. Also, many primary care physicians, who provide much of the care to migraine patients, may be less familiar with preventive medications.

Patients are also sometimes hesitant to go on a daily drug regimen that may cause side effects when they do not have headaches every day.

"Most clinicians are seeing so many patients per day and treating migraines really as an acute event," said Eric Wall, MD, MPH, clinical associate professor of family medicine at Oregon Health & Science University in Portland and the representative to the Headache Consortium from the American Academy of Family Physicians.

"Also, patients themselves are not very much attuned to preventive treatment."

ADDITIONAL INFORMATION:

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When only prescription costs were taken into account, the use of medication to prevent migraines resulted in average per-person savings of $1,321.27 for heavy users of acute medication. Savings for those using slightly less acute medication averaged $553.05. For all regular users of acute medication, outpatient visits declined 51.1%; emergency departments visits decreased 81.8%.

Source: Headache, The Journal of Head and Face Pain, March