Health Care Utilization and Mortality in People Living with Migraine and Comorbid Depression: A Retrospective Cohort Study
Thomas Williams1, Conor Kelly1, Robert Kaniecki2, Jason Raad3, Janel Hanmer4, Manisha Jhamb3, Parthasarathy Thirumala4
1UPMC, 2The University of Pittsburgh Headache Center, 3University of Pittsburgh, 4University of Pittsburgh Medical Center
Objective:

Report how depression affects mortality and unplanned healthcare utilization of patients with migraine by utilizing Patient-Reported Outcomes Measurement Information System (PROMIS) scores collected in routine practice at neurology clinics within an academic health system.

Background:

In people suffering from migraine headaches, co-existent mental health conditions like depression have a significant effect on quality of life, albeit, data on unplanned resource utilization is limited.

Design/Methods:
A retrospective, single center cohort analysis was performed of PROMIS depression measures from 2018 through 2023. We evaluated the effect of these measures on unplanned resource utilization as measured by Mortality – all cause, Hospitalization - all cause, ED Treatment and Telease - all cause, and Urgent Care - all cause, at 7, 30, and 90-days from index clinic visit. Univariate analysis was utilized to evaluate differences between groups.
Results:

The cohort consisted of 21,177 unique patients suffering from migraine headaches, totaling 39,590 encounters. Within our cohort, the incidence of depression was 8.9%, median age was 43.8 yrs, with 83.5% being female. Patients with abnormal PROMIS Depression scores (>60) were more likely to experience adverse outcomes. At 30 days post the index visit, their likelihood of mortality was significantly higher (10.039, 95% CI: 1.044-96.538), as was the case at 90 days (4.688, 95% CI: 1.487-14.77). Additionally, they were more prone to hospitalization for all causes at both 30 days (1.327, 95% CI: 1.02-1.72) and 90 days (1.52, 95% CI: 1.29-1.79). Furthermore, they exhibited increased utilization of emergency department services at 7 days (1.55, 95% CI: 1.169-2.059), 30 days (1.32, 95% CI: 1.02-1.72), and 90 days (1.724, 95% CI: 1.54-1.921).

Conclusions:

People living with migraine headaches with comorbid depression were more likely to experience all-cause mortality and unplanned hospitalization at 30 and 90 days. Adequate treatment of depression in people with migraine may be critical in improving these outcomes.

10.1212/WNL.0000000000205886