Burden of Migraine and Migraine-Associated Symptoms in People with Differing Ethnic and Racial Backgrounds: Results of the OVERCOME (US) Study
Dawn C. Buse1, Betzaida Martinez2, E. Jolanda Muenzel2, Robert A. Nicholson2, Anthony J Zagar2, Fred Cohen3, Susan Hutchinson4, Sait Ashina5, Robert E. Shapiro6, Eric M. Pearlman2, Richard B. Lipton7
1Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA, 2Eli Lilly and Company, Indianapolis, IN, USA, 3Mount Sinai Center for Headache and Facial Pain, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA, 4Orange County Migraine and Headache Center, Irvine, CA, USA, 5Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine and Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA, 6Department of Neurological Sciences, Larner College of Medicine, University of Vermont, Burlington, VT, USA, 7Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA and Montefiore Medical Center, Bronx, NY, USA
Objective:
Examine migraine burden and associated symptoms in ethnoracial subgroups.
Background:
Migraine burden (disability, interictal burden, quality of life) and symptoms may differ by race/ethnicity.
Design/Methods:
Baseline cohorts of OVERCOME (US), a population-based web survey conducted with annually (2018-2020) recruited demographically representative adult samples identified 59,001 respondents who met ICHD-3 criteria for migraine. Due to large sample size, standardized mean difference (SMD, values <0.2=no difference, 0.2-0.49=small difference, 0.5-0.79=moderate difference) was used to compare individuals by race and ethnicity (Black/White, Hispanic/non-Hispanic, and cross-classifications) regarding 1)migraine burden assessed via Migraine Disability Assessment Scale(MIDAS), Migraine Interictal Burden Scale(MIBS-4), Migraine-specific Quality of Life Questionnaire(MSQ), and 2)symptoms assessed via head pain severity, Migraine Symptom Severity Scale(MSSS), and Allodynia Symptom Checklist(ASC-12).
Results:
Among participants who reported their race and ethnicity (n=56,667), 75.0% (n=42,477) were female, and 85.5% (n=48,435) had health insurance; 88.9% (n=50,391) identified as non-Hispanic, 79.7% (n=45,138) as White, 11.1% (n=6,276) as Hispanic, and 8.8% (n=5,012) as Black. The proportion with moderate/severe migraine-related disability (MIDAS) was similar across race (Black=42.6% vs White=44.2%,SMD<0.2), and ethnicity (Hispanic=47.5% vs non-Hispanic=43.9%,SMD<0.2). A higher proportion of those identifying as Hispanic reported moderate/severe interictal burden (MIBS-4) vs non-Hispanic (64.6% vs 52.2%,SMD=0.26); this was highest among the Hispanic-Black population (74.6%) vs non-Hispanic-White (50.8%,SMD=0.51) and vs non-Hispanic-Black (56.8%,SMD=0.38). Quality of life (MSQ-RFP) was poorer in Hispanics (59.1±26.8) vs non-Hispanics (64.6±26.5,SMD=0.23). While mean headache pain severity, migraine symptom severity (MSSS), and ictal cutaneous allodynia (ASC-12) were similar across groups (SMD<0.2), neck pain was more common in White vs Black population (42.9% vs 32.8%,SMD=0.21).
Conclusions:
Migraine burden and associated symptoms differ by ethnic and racial subgroups. Future research will consider the role of socioeconomic factors and comorbidities that may modify the associations among race, ethnicity, and indicators of migraine burden, and control for factors that may influence migraine-associated symptoms (e.g. headache day frequency, acute medication use).