title: Increase in migraine diagnoses and guideline-concordant treatment in veterans, 2004-2012.
abstract: Background and aim Health administrators, policy makers, and educators have attempted to increase guideline adherence of migraine medications while reducing inappropriate use of opioid- and barbiturate-containing medications. We evaluated the burden of migraine and proportion of guideline-concordant care in a large, national health care system over time. Methods We conducted a time-series study using data from the Veterans Health Administration (VHA) electronic health record. Veterans with migraines were identified by ICD-9 code (346.X). Prescriptions and comorbid conditions were evaluated before and after migraine diagnosis. Chi-square tests and logistic regression were performed. Results A total of 57,064 veterans were diagnosed with migraine headache (5.3%), with women significantly more likely diagnosed (11.6% vs. 4.4%, p < 0.0001). The number of veterans diagnosed with migraine has significantly increased over the years. By 2012, triptans were prescribed to 43% of people with migraine, with no difference by gender. However, triptan prescriptions increased from 2004 to 2012 in men, but not women, veterans. Preventive medicines showed a significant increase with the year of migraine diagnosis, after controlling for age, sex, race, and for comorbidities treated with medications used for migraine prevention. Conclusions The burden of migraines is increasing within the VHA, with a corresponding increase in the delivery of guideline-concordant acute and prophylactic migraine-specific medication.
authors.affiliation: 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.|2 Yale University, Department of Neurology, USA.|3 Yale University, Department of Psychiatry, USA.
authors.forename: H H
authors.initials: HH
authors.lastname: Altalib
authors.affiliation: 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.
authors.forename: B T
authors.initials: BT
authors.lastname: Fenton
authors.affiliation: 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.|2 Yale University, Department of Neurology, USA.
authors.forename: J
authors.initials: J
authors.lastname: Sico
authors.affiliation: 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.|3 Yale University, Department of Psychiatry, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Goulet
authors.affiliation: 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.
authors.forename: H
authors.initials: H
authors.lastname: Bathulapalli
authors.affiliation: 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.|4 Yale University, Department of Internal Medicine, USA.
authors.forename: A
authors.initials: A
authors.lastname: Mohammad
authors.affiliation: 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.|3 Yale University, Department of Psychiatry, USA.
authors.forename: J
authors.initials: J
authors.lastname: Kulas
authors.affiliation: 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.|3 Yale University, Department of Psychiatry, USA.
authors.forename: M
authors.initials: M
authors.lastname: Driscoll
authors.affiliation: 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.|5 Yale University, Department of Emergency Medicine, USA.
authors.forename: J
authors.initials: J
authors.lastname: Dziura
authors.affiliation: 6 VA Central Western Massachusetts Healthcare System, USA.|7 University of Massachusetts Medical School, Department of Quantitative Health Science, USA.
authors.forename: K
authors.initials: K
authors.lastname: Mattocks
authors.affiliation: 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.|2 Yale University, Department of Neurology, USA.|3 Yale University, Department of Psychiatry, USA.
authors.forename: R
authors.initials: R
authors.lastname: Kerns
authors.affiliation: 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.|5 Yale University, Department of Emergency Medicine, USA.
authors.forename: C
authors.initials: C
authors.lastname: Brandt
authors.affiliation: 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.|4 Yale University, Department of Internal Medicine, USA.
authors.forename: S
authors.initials: S
authors.lastname: Haskell
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D000700:Analgesics
keywords: Veterans; guideline concordance; migraine