Epidemiology and Equity of Acute Migraine Care Among VHA Enrolled Veterans
Elinor Laffargue1, Harini Bathulapalli1, John Ney1, Daniel Rogers1, Elizabeth Seng2, Allison Willis3
1VA Connecticut Healthcare System, 2Yeshiva University, Albert Einstein College of Medicine, 3Neurology, University of Pennsylvania Perelman School of Medicine
Objective:

To describe VHA-based treatment of acute migraine among veterans.

Background:

Acute migraine treatments include over the counter and prescription medications. Calcitonin gene-related peptide (CGRP) receptor antagonists (gepants) are a newer treatment option. Few studies have described real-world prescribing, particularly for gepants, and updated data are needed to assess their use.

Design/Methods:

We conducted a retrospective cross-sectional study using VHA administrative data, including veterans with a migraine-related visit in FY2024, and followed them through available FY25 data to assess prescriptions of triptans, gepants, or ergotamines, and a composite of any of the three. Multivariable logistic regression models assessed associations between sociodemographic factors and prescribing. Results are presented as adjusted odds ratios with 95% confidence intervals.

Results:

Among 376,030 veterans, 43.0% were prescribed any acute migraine medication, most commonly triptans (39.3%), followed by gepants (5.7%), or ergotamines (<1%). Black, Asian, and Pacific Islander veterans had greater odds of any prescription (aORs = 1.19-1.28) or a triptan (aORs = 1.21-1.37), but lower odds of gepants (aORs = 0.70-0.83) compared to White veterans. Older age (continuous) was associated with lower odds of any prescription (aOR = 0.98; 0.98–0.98) and triptans (aOR = 0.98; 0.98-0.98), but higher odds of gepants (aOR = 1.01; 1.01–1.01). Age-race interactions showed Black veterans ≥65 had higher odds of any prescription compared to White veterans ≥65 (aOR = 1.17; 1.11–1.23). Female veterans had lower odds of any prescription (aOR = 0.89; 0.88–0.91) and triptans (aOR = 0.82, 0.81–0.83), but higher odds of gepants (aOR = 1.69; 1.64–1.74). Rural residence was associated with lower odds of any prescription (aOR = 0.93; 0.92, 0.94) and triptans (aOR=0.92; 0.91, 0.93). Highly rural residence was associated with lower prescriptions across all outcomes (aORs = 0.78-0.88).

Conclusions:

Acute migraine medication prescribing in the VHA varied by sociodemographic factors, highlighting access disparities.

10.1212/WNL.0000000000216214
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.