--- title: "The migraine signature study: methods and baseline results | Sutter Health" description: "Migraine is a common reason for seeking primary and neurology care, but little is documented about who seeks care and factors that explain variation utilization" url: "https://www.sutterhealth.org/research/publications/the-migraine-signature-study-methods-baseline-results-1055312789" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. The migraine signature study: methods and baseline results # The migraine signature study: methods and baseline results Pressman AR, Buse DC, Jacobson AS, Vaidya SJ, Scott AB, Chia VM, Szekely CA, Stewart WF, & Lipton RB _Headache. doi: 10.1111/head.14033. Online ahead of print._ 2020-12-23 ## Abstract ****Objective:**** To characterize patients who utilize services for migraine in a large integrated health care network, and describe patterns of care and utilization. ****Background:**** Within health care systems, migraine is a common reason for seeking primary and neurology care, but relatively little is documented about who seeks care and the factors that explain variation in utilization. ****Methods:**** We conducted a retrospective cohort study using electronic health record (EHR) data from Sutter Health primary care (PC) patients who had at least one office visit to a PC clinic between 2013 and 2017. Migraine status was ascertained from diagnosis codes and medication orders. Control status was assigned to those with no evidence of care for any type of headache. We divided the primary care migraine cohort into two groups: those who received all their care for migraine from PC (denoted PC-M) and those who had ≥1 encounter with a neurologist for migraine (denoted N-M). Migraine cases were also designated as having preexisting migraine if they had an encounter with a migraine diagnosis within (±) 6 months of their first study period PC visit and, otherwise, designated as first migraine consult. Two levels of contrasts included: patients with migraine and controls; and within the group of patients with migraine, PC-M and N-M groups. Comorbid conditions were determined from EHR encounter diagnosis codes. ****Results:**** We identified 94,149 patients with migraine (including 21,525 N-M and 72,624 PC-M) and 1,248,763 controls. Comorbidities: Proportions of psychiatric \[29.8% (n = 28,054) vs. 11.8% (n = 147,043)\], autoimmune \[(4.4% (n = 4162) vs. 2.6% (n = 31,981)\], pain \[13.2% (n = 12,439) vs. 5.8% (n = 72,049)\], respiratory \[24.6% (n = 23,186) vs. 12.3% (n = 153,692)\], neurologic \[2.9% (n = 2688) vs. 0.9% (n = 11,321)\], and cerebrovascular \[1.0% (n = 945) vs. 0.6% (n = 7500)\] conditions were higher in the migraine group compared to controls, all p < 0.001. Among patients with migraine, the N-M group was similar to the PC-M group in sex, age, ethnicity, and marital status, but were more likely to have preexisting migraine (49.9% (n = 10,734) vs. 36.2% (n = 26,317), p < 0.001). Proportions of comorbid conditions were higher among the N-M group than the PC-M group {psychiatric \[38.5% (n = 8291) vs. 27.2% (n = 19,763)\], autoimmune \[6.3% (n = 1365) vs. 3.9% (n = 2797)\], pain \[19.6% (n = 4218) vs. 11.3% (n = 8211)\], respiratory \[30.3% (n = 6516) vs. 23.0% (n = 16,670)\], neurologic \[6.0% (n = 1288) vs. 1.9% (n = 1400)\], cardiovascular \[9.7% (n = 2091) vs. 7.0% (n = 5076)\], and cerebrovascular \[2.3% (n = 500) vs. 0.6% (n = 445)\], all p < 0.001}. Medications: During the study period, 82.6% (n = 77,762) of patients with migraine received ≥1 prescription order for an acute migraine medication \[89.4% (n = 19,250) of N-M vs. 80.6% (n = 58,512) of PC\]. Opioids were prescribed to 52.9% (n = 49,837) of patients with migraine \[63.5% (n = 13,669) for N-M and 49.8% (n = 36,168) for PC-M patients). During the study period, 61.4% (n = 57,810) of patients received ≥1 prescription for a migraine preventive medication \[81.4% (n = 17,521) of N-M and 55.5% (n = 40,289) of PC-M patients\]. The most commonly prescribed classes of preventive medications were antidepressants. ****Conclusions:**** Among patients with migraine in a large health system, those who were also cared for in neurology were more likely to receive both acute and preventive medication migraine orders than those patients who did not see a neurologist, with triptans and antidepressants the most commonly prescribed classes of acute and preventive pharmacotherapies, respectively. Opioids were prescribed to approximately half of the total sample and more common in the N-M group. Adjusting for demographics, patients with migraine had higher rates of nearly every comorbidity we assessed and were more likely to utilize services compared to those without migraine. Overall, patients with migraine also cared for in neurology practices used more of all health care resource types under consideration and had more medical issues, which may be due in some part to a more severe, frequent and disabling disease state compared to those who sought care exclusively from PC practices. [PubMed abstract](https://pubmed.ncbi.nlm.nih.gov/33368248/) ## Research topics - [EHR Data](https://www.sutterhealth.org/research-search-results?query=%22%5C%22EHR+Data%5C%22%22) - [Migraine](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Migraine%5C%22%22) - [Primary Care](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Primary+Care%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [A population-health approach to characterizing migraine by comorbidity: Results from the Mindfulness and Migraine Cohort Study](https://www.sutterhealth.org/research/publications/population-health-approach-to-migraine-by-comorbidity-1055312846) Sudat SE, Jacobson AS et al. A population-health approach to characterizing migraine by comorbidity: Results from the Mindfulness and migraine study Cephalalgia. 2022;42(11-12):1255-1264. doi:10.1177/03331024221104180 2022 May 31 - Publication ### [Patients' Perspectives on Plans Generated During Primary Care Visits and Self-Reported Adherence at 3 Months: Data From a Randomized Trial](https://www.sutterhealth.org/research/publications/primary-care-visits-self-reported-adherence-at-3-months-1055312639) Journal of Participatory Medicine 2024 Mar 14 - Publication ### [New and sex-specific migraine susceptibility loci identified from a multiethnic genome-wide meta-analysis](https://www.sutterhealth.org/research/publications/new-sex-specific-migraine-susceptibility-1055312836) Choquet H, Yin J, Jacobson AS, Horton BH, Hoffmann TJ, Jorgenson E, Avins AL, Pressman AR Commun Biol.4(1):864. doi: 10.1038/s42003-021-02356-y. 2021 Jul 22 - Publication ### [Evaluating the Impact of a Point-of-Care Cardiometabolic Clinical Decision Support Tool on Clinical Efficiency Using Electronic Health Record Audit Log Data: Algorithm Development and Validation](https://www.sutterhealth.org/research/publications/evaluating-impact-of-poc-cardiometabolic-clinical-care-tool-1055312804) JMIR Medical Informatics 2022 Sep 06 - Publication ### [Medication non-adherence and therapeutic inertia independently contribute to poor disease control for cardiometabolic diseases](https://www.sutterhealth.org/research/publications/medication-non-adherence-cardiometabolic-disease-1055312898) Scientific Reports 2022 Nov 07 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/the-migraine-signature-study-methods-baseline-results-1055312789#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"The migraine signature study: methods and baseline results"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/the-migraine-signature-study-methods-baseline-results-1055312789#medicalscholarlyarticle","name":"The migraine signature study: methods and baseline results","headline":"The migraine signature study: methods and baseline results","abstract":"Objective: To characterize patients who utilize services for migraine in a large integrated health care network, and describe patterns of care and utilization. Background: Within health care systems, migraine is a common reason for seeking primary and neurology care, but relatively little is documented about who seeks care and the factors that explain variation in utilization. Methods: We conducted a retrospective cohort study using electronic health record (EHR) data from Sutter Health primary care (PC) patients who had at least one office visit to a PC clinic between 2013 and 2017. Migraine status was ascertained from diagnosis codes and medication orders. Control status was assigned to those with no evidence of care for any type of headache. We divided the primary care migraine cohort into two groups: those who received all their care for migraine from PC (denoted PC-M) and those who had ≥1 encounter with a neurologist for migraine (denoted N-M). Migraine cases were also designated as having preexisting migraine if they had an encounter with a migraine diagnosis within (±) 6 months of their first study period PC visit and, otherwise, designated as first migraine consult. Two levels of contrasts included: patients with migraine and controls; and within the group of patients with migraine, PC-M and N-M groups. Comorbid conditions were determined from EHR encounter diagnosis codes. Results: We identified 94,149 patients with migraine (including 21,525 N-M and 72,624 PC-M) and 1,248,763 controls. Comorbidities: Proportions of psychiatric [29.8% (n = 28,054) vs. 11.8% (n = 147,043)], autoimmune [(4.4% (n = 4162) vs. 2.6% (n = 31,981)], pain [13.2% (n = 12,439) vs. 5.8% (n = 72,049)], respiratory [24.6% (n = 23,186) vs. 12.3% (n = 153,692)], neurologic [2.9% (n = 2688) vs. 0.9% (n = 11,321)], and cerebrovascular [1.0% (n = 945) vs. 0.6% (n = 7500)] conditions were higher in the migraine group compared to controls, all p \u003c 0.001. Among patients with migraine, the N-M group was similar to the PC-M group in sex, age, ethnicity, and marital status, but were more likely to have preexisting migraine (49.9% (n = 10,734) vs. 36.2% (n = 26,317), p \u003c 0.001). Proportions of comorbid conditions were higher among the N-M group than the PC-M group {psychiatric [38.5% (n = 8291) vs. 27.2% (n = 19,763)], autoimmune [6.3% (n = 1365) vs. 3.9% (n = 2797)], pain [19.6% (n = 4218) vs. 11.3% (n = 8211)], respiratory [30.3% (n = 6516) vs. 23.0% (n = 16,670)], neurologic [6.0% (n = 1288) vs. 1.9% (n = 1400)], cardiovascular [9.7% (n = 2091) vs. 7.0% (n = 5076)], and cerebrovascular [2.3% (n = 500) vs. 0.6% (n = 445)], all p \u003c 0.001}. Medications: During the study period, 82.6% (n = 77,762) of patients with migraine received ≥1 prescription order for an acute migraine medication [89.4% (n = 19,250) of N-M vs. 80.6% (n = 58,512) of PC]. Opioids were prescribed to 52.9% (n = 49,837) of patients with migraine [63.5% (n = 13,669) for N-M and 49.8% (n = 36,168) for PC-M patients). During the study period, 61.4% (n = 57,810) of patients received ≥1 prescription for a migraine preventive medication [81.4% (n = 17,521) of N-M and 55.5% (n = 40,289) of PC-M patients]. The most commonly prescribed classes of preventive medications were antidepressants. Conclusions: Among patients with migraine in a large health system, those who were also cared for in neurology were more likely to receive both acute and preventive medication migraine orders than those patients who did not see a neurologist, with triptans and antidepressants the most commonly prescribed classes of acute and preventive pharmacotherapies, respectively. Opioids were prescribed to approximately half of the total sample and more common in the N-M group. Adjusting for demographics, patients with migraine had higher rates of nearly every comorbidity we assessed and were more likely to utilize services compared to those without migraine. Overall, patients with migraine also cared for in neurology practices used more of all health care resource types under consideration and had more medical issues, which may be due in some part to a more severe, frequent and disabling disease state compared to those who sought care exclusively from PC practices.","description":"Migraine is a common reason for seeking primary and neurology care, but little is documented about who seeks care and factors that explain variation utilization","keywords":["EHR Data","Migraine","Primary Care"],"datePublished":"2020-12-23","url":"https://www.sutterhealth.org/research/publications/the-migraine-signature-study-methods-baseline-results-1055312789","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"33368248"},{"@type":"PropertyValue","propertyID":"DOI","value":"10.1111/head.14033"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/33368248/","https://doi.org/10.1111/head.14033"],"isPartOf":{"@type":"Periodical","name":"Headache"},"author":[{"@type":"Person","name":"Pressman AR"},{"@type":"Person","name":"Buse DC"},{"@type":"Person","name":"Jacobson AS"},{"@type":"Person","name":"Vaidya SJ"},{"@type":"Person","name":"Scott AB"},{"@type":"Person","name":"Chia VM"},{"@type":"Person","name":"Szekely CA"},{"@type":"Person","name":"Stewart WF"},{"@type":"Person","name":"Lipton RB"}],"about":[{"@type":"DefinedTerm","name":"EHR Data","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22EHR+Data%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Migraine","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Migraine%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Primary Care","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Primary+Care%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/the-migraine-signature-study-methods-baseline-results-1055312789","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/the-migraine-signature-study-methods-baseline-results-1055312789#breadcrumblist"}}} ```