Underdiagnosis and impact of menstrual migraine in real-world clinical practice: A real-world survey.

Abstract

Objective: This cross-sectional study aimed to evaluate the frequency of menstrual migraine (MM) reporting in clinical practice and to compare the clinical burden, treatment patterns, and patient satisfaction between those with and without MM.

Background: People with MM experience more severe, disabling, and prolonged attacks than people with non-MM. Research indicates that approximately two thirds of females with migraine may experience MM; however, the prevalence of MM is often underreported and there is a lack of awareness regarding the condition.

Methods: This study analyzed secondary data from the Adelphi Real World Migraine Disease Specific Programme™, a cross-sectional survey with retrospective data collection conducted across France, Germany, Italy, Spain, the United Kingdom, and the United States from May 2022 to February 2024. Physicians completed an attitudinal survey, and provided data for consecutively consulting patients with migraine, containing questions on demographics, clinical characteristics, treatment history (including reasons for treatment choice, treatment satisfaction, and adherence), and symptomatic burden. Patients voluntarily completed a questionnaire on their current symptom burden, migraine pain severity, treatment satisfaction, and other patient-reported outcomes. Outcomes between patients with and without a physician-confirmed diagnosis of MM were compared using statistical and comparative tests. Patients were eligible for inclusion if they were female, aged 18-55 years, and had menstrual periods.

Results: Overall, 627 physicians reported data on 3215 patients who met the inclusion criteria, with 1037 (32.3%) having a physician-confirmed diagnosis of MM. The patient questionnaire was completed by 931 patients, of whom 340 (36.5%) had a physician-confirmed diagnosis of MM. While physicians estimated on average that 38.5% of their patients experienced MM, 32.3% of patients had a physician-confirmed diagnosis of MM, as reported from the individual patient record forms. Additionally, 14.0% of patients without a physician-confirmed diagnosis of MM self-reported menstruation as a trigger for their migraine. Clinically, there were few differences observed between patient groups, except for higher migraine attack severity in patients with MM (p < 0.001). Patients with and without MM were prescribed a similar number of acute treatments (mean [standard deviation, SD]: both 1.1 [0.7]), but patients with physician-confirmed MM were prescribed fewer preventive treatments (mean [SD]: 0.5 [0.6] vs. 0.6 [0.6], p < 0.001). Lower physician-reported satisfaction with acute (21.6% vs. 29.4%, p = 0.024) and preventative treatment (22.0% vs. 34.8%, p = 0.010) was observed in patients with MM compared to those without MM. Patients with MM also reported less satisfaction with their acute treatment than those without MM (19.4% vs. 27.8%, p = 0.013).

Conclusions: This study highlights differences between patients with and without MM. Patients with MM experienced more severe attacks and reported lower treatment satisfaction, according to both patients and their physicians, compared to those without MM. Further real-world insights on patient experience, including migraine attack severity, are necessary to alleviate the burden of MM.