Sex and race disparities among patients on migraine-prevention therapies in the United States

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.