• Stephen D Silberstein, Lulu Lee, Kavita Gandhi, Timothy Fitzgerald, Jvawnna Bell, and Joshua M Cohen.
• Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA.
• Headache. 2018 Nov 1; 58 (10): 1579-1592.

ObjectiveTo examine the disability, health care resource utilization, and direct annual costs among patients with migraine, categorized according to the number of headache days experienced in the past month.BackgroundMigraine exists on a continuum of different attack frequencies and associated levels of disability. People with migraine have increased health care utilization and incur substantially more direct costs than those without the disease. While the broad implications of migraine are evident, there is a need to comprehensively describe the impact of headache frequency on the burden of illness.Design/MethodsData from a cross-sectional, self-administered, Internet-based survey of respondents recruited from the US National Health and Wellness Survey panel were assessed. Adults who had self-reported migraine diagnosis or migraine symptoms in the past 3 months were grouped by their frequency of headache days in the past month: low-frequency episodic migraine (LFEM, <4 days), moderate-frequency episodic migraine (MFEM, 4-9 days), high-frequency episodic migraine (HFEM, 10-14 days), and chronic migraine (CM, ≥15 days). Headache-related disability was determined from the Headache Impact Test (HIT-6) scores, and health care resource utilization was assessed by the number of ER visits, hospitalizations, and visits to health care practitioners (HCPs) in the past 12 months. The estimated annual direct costs were calculated from the number of each type of visit and all-cause cost data from the 2014 Medical Expenditure Panel Survey.ResultsA total of 1347 patients (LFEM, n = 813; MFEM, n = 301; HFEM, n = 105; CM, n = 128) were included. Patient groups differed significantly by comorbidity index, education and income level, alcohol consumption, and insurance type. Overall, patients with LFEM had the least disability and lowest health care utilization and direct costs. Patients with CM scored 3.7 points (adjusted mean score [95% confidence interval, CI] 68.2 [67.3, 69.0] points) higher on HIT-6 compared with those in the LFEM group (64.5 points [64.1, 64.8]), while those with HFEM and MFEM scored 2.4 (66.8 points [65.9, 67.8]) and 2.3 (66.7 points [66.2, 67.3]) points higher, respectively (all, P < .001). The CM and MFEM groups reported significantly more HCP visits ([mean ± standard error] CM: 7.03 ± 0.83; MFEM: 5.34 ± 0.42; vs LFEM: 3.48 ± 0.18; both, P < .001) and migraine-related hospitalizations (CM: 0.06 ± 0.03; MFEM: 0.05 ± 0.02; vs LFEM: 0.02 ± 0.01; both, P < .05) than the LFEM group. There were significant differences in the total direct costs between the CM and MFEM groups compared with the LFEM group (CM: $3155 ± $609; MFEM: $2721 ± $342; vs LFEM: $1560 ± $118; both, P < .001), with differences largely driven by costs of HCP visits.ConclusionsIn patients with migraine, as the number of headache days increased, so did the burden of disease (disability, health care utilization, and direct costs). Elucidating the burden associated with EM and CM has implications for guiding treatment decisions and management of patients with migraine.© 2018 American Headache Society.

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