Sex and race disparities in the migraine community have been revealed by an audit of patients prescribed a calcitonin gene-related peptide monoclonal antibody or onabotulinumtoxinA. Headache specialist, Professor Robert Cowan, Stanford University, CA, detailed these disparities in a scientific session at AAN 2021.
Data for 1003 patients with migraine recently prescribed a calcitonin gene-related peptide (CGRP) monoclonal antibody or onabotulinumtoxinA were provided by 230 physicians located throughout the US in May/June 2020,1 explained Professor Cowan.
Females were younger than males when they experienced their first migraine episode and at diagnosis
Sex data and disparities
Among the 1003 patients, 710 were female and 293 were male, said Professor Cowan. Males were more likely to be managed by migraine specialists than females (52% vs 36%).1
Females were younger than males when they experienced their first migraine episode (22.7 vs 29.1 years) and at diagnosis (26.1 vs 32.0 years), which was more likely to be:
- Chronic migraine—i.e. at least 15 headache days per month with at least 8 migraine days2—in females (41% vs 24%)
- Low-frequency episodic migraine—i.e. 1–8 headache days per month with 1–3 migraine days—in males (28% vs 16%)1
Females were more likely to have a diagnosis of chronic migraine
High-frequency episodic migraine—i.e. 9–14 headache days per month with 4–7 migraine days—was diagnosed in 48% of males and 43% of females. 1
Professor Cowan highlighted that among the females, 68% had previously failed at least two previous preventive therapies, while 51% of males had failed one preventive therapy. Furthermore, males were more likely to have been prescribed a CGRP monoclonal antibody.1
Comorbid hypertension was more common among males (21% vs 13%), whereas anxiety and depression were more common in females (17% vs 8% and 27% vs 21%, respectively).1
Race data and disparities
Caucasians were younger than minorities when they experienced their first migraine episode and at diagnosis
Most patients were Caucasian (n=765), while 238 were classified as minority (i.e. African-American, Latino/Hispanic, Asian). Minority males were more likely to be managed by a migraine specialist than white females (56% vs 35%).1
Caucasians were younger than minorities when they experienced their first migraine episode and at diagnosis,1 said Professor Cowan.
Comorbid hypertension was more common among minorities (21% vs 13%), and the highest rates were among Caucasian males (23%) and minority females (24%).1
Minority males were more likely to be managed by a migraine specialist than white females
Minorities, especially minority females, were more likely covered by government plans (25% vs 13%), and minority females were more likely to be covered by Medicaid (15% vs 7%), commented Professor Cowan.1
Therapy selection among minority patients was more often influenced by:
- Patient request (32% vs 24%)
- Expectation of speed of efficacy onset (29% vs 22%)
- Family planning consideration (12% vs 3%)
- Concern about non-adherence (11% vs 5%)1
Need for further investigation
Professor Cowan concluded that culture, comorbidities, and economics probably contribute to these racial and sexual disparities in the migraine community and that their causes and implications require further investigation.
Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.
