Real-world Diagnosis of Chronic Migraine in Patients with Cervical Dystonia Analyzed by Botulinum Neurotoxin Treatment Exposure: An Epidemiologic Perspective
Ramon Rodriguez1, Susan W. Broner2, Grace Forde3, Christopher Rhyne4, Marjan Sadeghi5, Emma Xiaomeng Yue5, Ahunna Ukah5, Kimberly Becker Ifantides5, Harini Sarva2
1Neurology One, 2Weill Cornell Medicine, 3NeuroPain Care Center, 4Norton Neuroscience Institute, 5AbbVie
Objective:
Describe the real-world diagnosis, demographics, and clinical characteristics of chronic migraine (CM) in cervical dystonia (CD) patients stratified by botulinum neurotoxin (BoNT) treatment.
Background:
Migraine is a common comorbidity in patients with CD; however, the diagnosis of CM in patients with CD is unknown.
Design/Methods:
This observational retrospective cohort study used longitudinal patient-level data from the Optum Market Clarity Database in the US. CD cohort includes patients ≥18y with ≥2 CD diagnoses ≥30d apart during the study (January 1, 2017 - September 30, 2021) and ≥180d of continuous health plan enrollment prior to cohort entry (first CD diagnosis coding). Cohort 1: CD+migraine/headache patients; cohort 2: CD+CM patients; cohorts 3 and 4: CD+CM BoNT- treated and CD+CM BoNT-untreated patients, respectively. Assessments include diagnosis, demographics and clinical characteristics of migraine/headache and CM in the CD cohort.
Results:
Of 81,884 CD patients, 36.1% had migraine/headache (cohort 1, n=29,533) and 12.6% had concurrent CM (cohort 2, n=10,284). There were more CD+CM patients in cohort 4 (BoNT-untreated) than cohort 3 (BoNT-treated) (57.4% vs 42.6%); cohort 3 had more older patients and fewer African Americans. Common comorbidities were comparable across cohorts 1-4 (neck pain, range: 63.6%-78.8%; psychiatric conditions, range: 37.5%-43.3%). The proportion of patients with psychiatric conditions in the CD+CM cohort (42.9%) was greater as compared to the overall CD cohort (28.1%). OnabotulinumtoxinA was the most used BoNT for CD or CM across cohorts 1-3. CD+CM patients treated with BoNT for both CD and CM diagnoses were higher (24.6%) than those treated for CD or CM individually (19.6% and 16.6%).
Conclusions:
CM is a common comorbidity in CD patients. Providers should be aware that patients may have both CD and CM, underscoring the importance of diagnosis and selection of appropriate treatment for managing these disease states. Further study is needed on the clinical phenotype of CD in CM patients.
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