Rationale for Correct Answer

The correct answer is: Higher household income

Barriers to accurate diagnosis and appropriate migraine treatment include lack of appropriate medical consultation, failure to receive an accurate diagnosis, not being offered a regimen with acute and preventive pharmacologic treatments (if indicated), and not avoiding medication overuse. Data from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study were analyzed to better understand sociodemographic factors associated with successful negotiation of these barriers in more than 9000 patients with episodic or chronic migraine and associated disability in the United States.

Only 8.5% of patients with episodic migraine and 1.8% of patients with chronic migraine successfully traversed all 4 barriers. Factors significantly associated with higher rates of consultation were Black race, higher household income, and coverage with health insurance. Factors significantly associated with accurate diagnosis (among consulters) were female sex, higher household income, and coverage with health insurance. Among patients who had consulted an appropriate provider and received an accurate diagnosis, treatment rates increased with higher household income and were higher in insured versus uninsured patients. There was no significant association between treatment rates and sex, race, or ethnicity. Among patients who consulted an appropriate provider, received an accurate diagnosis, and received appropriate treatment, rates of medication overuse were significantly higher in men versus women and Black patients versus those of other races, while they decreased with increasing household income.

Buse DC, et al. Headache. 2021;61(4):628-41.