Ictal and Interictal Disability Associated with a Change in Migraine-related Stigma Questionnaire (MiRS) Over 1-year Among People with Migraine: Results from the OVERCOME (US) Study
Robert Shapiro1, Eva Muenzel2, Dawn Buse3, Elizabeth Seng4, Ali Sheikhi2, Sait Ashina5, Robert Nicholson2, Richard Lipton6
1Larner College of Medicine, University of Vermont, 2Eli Lilly & Company, 3Albert Einstein College of Medicine, 4Yeshiva University; Beth Israel Deaconess Medical Center, Harvard Medical School, 5Beth Israel Deaconess Medical Center, Harvard Medical School, 6Albert Einstein College of Medicine; Montefiore Medical Center
Objective:
To evaluate outcomes associated with change in migraine-related stigma questionnaire (MiRS) over 1-year among people with migraine.
Background:
MiRS is associated with worse migraine status. It is unknown if changes in MiRS over time are associated with changes in headache features and patient-reported outcomes (PROs).
Design/Methods:
The web-based OVERCOME (US) study recruited a sample of 61,932 US adults with active migraine using a validated diagnostic questionnaire1. MiRS was assessed at baseline and 1-year follow-up using the MiRS questionnaire (three ordinal stigma categories: never, rarely/sometimes, often/very often) and the population was categorized into three groups: MiRS improved (by ≥1 categories), stayed the same, and worsened (by ≥1 categories). Migraine-associated symptoms, monthly headache days (MHDs), migraine-related disability (MIDAS), migraine interictal burden (MIBS-4), and migraine-specific quality of life (MSQ-RFR) were evaluated. Standardized mean difference (SMD) was calculated to compare the outcomes among groups, <0.2 indicated no difference, and 0.2-0.49 indicated small difference.
Results:
A total of 11,634 respondents completed the baseline and 1-year follow-up surveys. Mean age (standard deviation) was 48.2 (14.1) years, 75.6% were female, and 84.4% were Caucasian. Over the 1-year follow-up, MiRS improved in 24.9% of respondents, 60.1% stayed the same and 15.0% worsened. Demographics, headache features, and MHDs were not associated with MiRS change (SMDs<0.2). Relative to those with worsened MiRS, more people in the improved MiRS group, reported improvements in MIDAS (20.9% vs 31.4%, SMD=0.24) and MIBS-4 (15.5% vs 32.0%, SMD=0.40). Among those with improved MiRS, pain severity (6.2 vs 7.0, SMD=0.37) and MSQ-RFR (72.3 vs 63.0, SMD=0.32) also improved over the 1-year follow-up.
Conclusions:
In the OVERCOME (US) population, MiRS improvement over 1-year was associated with improvement in MIDAS and MIBS-4, but not MHDs. Further studies are warranted to explore causal sequence and design interventions to reduce stigma and improve scores on other PROs.
1Bigal et al., 2008;48:1157-1168.