(400) Migraine management in the Veterans Health Administration clinics

Abstract

Migraines are a common cause of pain and lost productivity. Veterans are particularly vulnerable to developing migraines because of their relatively high rate of traumatic brain injury (TBI). Migraine provides an opportunity to explore pain management among Veterans since its guidelines are well-established across settings. We have conducted a cross-sectional study using administrative and clinical data from the VA National Patient Care Database, Decision Support Systems and the Corporate Data Warehouse. The study population is composed of Veterans from the VA’s Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn roster (N=749,037, discharged 10/1/2001-9/30/2010). Veterans with migraines were identified by ICD-9 code (346.X) for migraine headache. We counted “confirmed” migraines that were coded at least once in an inpatient stay and/or at least twice in outpatient visits. Prescriptions were examined in the year following migraine diagnosis. Covariates examined included sociodemographic variables as well as psychiatric and medical comorbidity including traumatic brain injury (TBI). The comorbidity timeframe was set to be 1 year before and up to six months following migraine diagnosis. Chi-squares and logistic regression were utilized. A total of 21,050 Veterans were diagnosed with migraine headache (2.8%), with women significantly more likely to be diagnosed (7.0% vs. 2.3%, p<.0001). Triptans were prescribed to 24% of migraineurs, with no difference between men and women. However, the examination of triptan prescriptions by the year of migraine diagnosis revealed four-fold increase over the years [8.7% prior to 2004 to 43.4% in 2010; chi square for trend=1028.81, p<.0001]. Statistically, but not clinically, significant differences in triptan prescription were observed in the presence of comorbidity, including increased triptan prescription with positive TBI screen. The current rate of triptan treatment surpasses estimates reported in the general population. Preventive medicines (e.g. anti-hypertensive, anti-depressant, anti-seizure) showed a significant but smaller increase over the year of migraine diagnosis (range 42-52%). Migraines are a common cause of pain and lost productivity. Veterans are particularly vulnerable to developing migraines because of their relatively high rate of traumatic brain injury (TBI). Migraine provides an opportunity to explore pain management among Veterans since its guidelines are well-established across settings. We have conducted a cross-sectional study using administrative and clinical data from the VA National Patient Care Database, Decision Support Systems and the Corporate Data Warehouse. The study population is composed of Veterans from the VA’s Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn roster (N=749,037, discharged 10/1/2001-9/30/2010). Veterans with migraines were identified by ICD-9 code (346.X) for migraine headache. We counted “confirmed” migraines that were coded at least once in an inpatient stay and/or at least twice in outpatient visits. Prescriptions were examined in the year following migraine diagnosis. Covariates examined included sociodemographic variables as well as psychiatric and medical comorbidity including traumatic brain injury (TBI). The comorbidity timeframe was set to be 1 year before and up to six months following migraine diagnosis. Chi-squares and logistic regression were utilized. A total of 21,050 Veterans were diagnosed with migraine headache (2.8%), with women significantly more likely to be diagnosed (7.0% vs. 2.3%, p<.0001). Triptans were prescribed to 24% of migraineurs, with no difference between men and women. However, the examination of triptan prescriptions by the year of migraine diagnosis revealed four-fold increase over the years [8.7% prior to 2004 to 43.4% in 2010; chi square for trend=1028.81, p<.0001]. Statistically, but not clinically, significant differences in triptan prescription were observed in the presence of comorbidity, including increased triptan prescription with positive TBI screen. The current rate of triptan treatment surpasses estimates reported in the general population. Preventive medicines (e.g. anti-hypertensive, anti-depressant, anti-seizure) showed a significant but smaller increase over the year of migraine diagnosis (range 42-52%).