Socioeconomic Factors Associated With Migraine Medication Prescription at a Tertiary Headache Center: A Retrospective Cohort Analysis.

Background and objectives: The socioeconomic and demographic factors affecting the prescription of migraine medications are underexplored. Understanding these factors is critical to addressing health. We used our tertiary headache center's prescription database to assess the demographic and socioeconomic factors associated with the prescription of acute and preventive migraine medications and the factors affecting the rollout of novel migraine medications.

Methods: We performed a retrospective cohort analysis using aggregated deidentified data of patients who had received care through the Stanford Headache Clinic using data adapted from the Stanford deidentified instance of the Observational Medical Outcomes Partnership Common Data Model. We included patients in California who had received a diagnosis of chronic migraine and had received at least 1 prescription from our clinic between 2018 and 2022. The types and volumes of prescriptions were assessed, as well as demographic factors (age, sex, race ethnicity, and zip code income quartile).

Results: A total of 4,213 patients met inclusion criteria, of whom 3,349 (79.5%) were women and 863 (20.5%) were men, with a mean age of 44.6 ± 14.7 years. Our group was predominantly White and non-Hispanic/non-Latino (2,381/4213, 56.5%) and came from zip codes whose median income ranged from $77,250 to $236,912 (2046/3298, 62.0%). Age, sex, and race-ethnicity were all found to be statistically significant factors in the selection of both acute and preventive medications for patients. Zip code income quartile played a limited role in prescription variation for both acute and preventive medications. Race-ethnicity was also a statistically significant factor for those who received a prescription for a calcitonin gene-related peptide (CGRP) monoclonal antibody and a gepant. Similarly, sex, race-ethnicity, and zip code income quartile were all factors in the rollout of the CGRP monoclonal antibodies and gepants (all p < 0.05), but age was not (p = 0.722 and p = 0.057, respectively). The second and third zip code income quartiles had the lowest prescription rates of the CGRP monoclonal antibodies and gepants during their rollout.

Discussion: Disparities in sex, race-ethnicity, and zip code income quartile were found among those who received medications and which acute and preventive migraine medications were prescribed. This may reflect that some groups may have received less headache-specific care before establishing with our clinic. Future research will seek to better illuminate the underlying reasons for this more clearly to enable solutions and ensure equitable care.