Shapiro Robert E, Muenzel Eva Jolanda, Nicholson Robert A, Zagar Anthony J, L Reed Michael, Buse Dawn C, Hutchinson Susan, Ashina Sait, Pearlman Eric M, Lipton Richard B
Department of Neurological Sciences, Larner College of Medicine, University of Vermont, Burlington, VT, USA.
Eli Lilly and Company, Indianapolis, IN, 46201, USA.
Neurol Ther. 2025 Feb;14(1):135-155. doi: 10.1007/s40120-024-00668-9. Epub 2024 Nov 2.
Despite a variety of available treatment options for migraine, many people with migraine do not seek medical care, thereby reducing opportunities for diagnosis and effective treatment and potentially leading to missed opportunities to reduce the burden of disease. Understanding why people hesitate to seek care for migraine may help healthcare professionals and advocates address barriers and improve outcomes. The aim of this study, in a large adult population sample in the United States (US), was to identify factors associated with and reasons for hesitating to seek healthcare for migraine.
The web-based OVERCOME (US) survey study identified adults with active migraine in a demographically representative US sample who answered questions about hesitating to seek care from a healthcare provider for migraine and reasons for hesitating. Supervised machine learning (random forest, least absolute shrinkage and selection operator) identified factors associated with hesitation; logistic regression models assessed association of factors on hesitation.
The study results show that of the 58,403 participants with active migraine who completed the OVERCOME (US) baseline survey and provided responses to the question on hesitating to seek care for migraine, 45.1% (n = 26,330/58,403) with migraine indicated that they had ever hesitated to seek care for migraine. Factors most associated with hesitating to seek care were hiding migraine (odds ratio [OR] = 2.69; 95% confidence interval [CI]: 2.50, 2.89), experiencing migraine-related stigma (OR = 2.13; 95% CI 1.95, 2.33), higher migraine-related disability (OR = 1.30; 95% CI 1.23, 1.38), and higher ictal cutaneous allodynia (OR = 1.26; 95% CI 1.19, 1.35). The most common reasons participants stated for hesitating included (1) 44.2% wanting to try and take care of migraine on their own, (2) 33.8% feeling that their migraine or headache would not be taken seriously, (3) 29.2% thinking that their migraine was not serious/painful enough, and (4) 27.4% not being able to afford it or not wanting to spend the money. The main limitation of the study includes the requirement for respondents to have internet, access which may have reflected cohort bias, and the quota sampling rather than random sampling to create a demographically representative sample.
Hesitating to seek migraine care is common and is most strongly associated with hiding the disease and migraine-related stigma. Those experiencing higher migraine-related burden are more hesitant to seek the care that might alleviate the burden. These findings suggest that migraine's social context (e.g., stigma) is a major determinant of hesitance to seek migraine care.
尽管有多种针对偏头痛的治疗选择，但许多偏头痛患者并未寻求医疗护理，从而减少了诊断和有效治疗的机会，并可能导致错失减轻疾病负担的机会。了解人们为何不愿寻求偏头痛治疗，可能有助于医疗保健专业人员和倡导者消除障碍并改善治疗效果。本研究在美国的大量成年人口样本中的目的是确定与因偏头痛而犹豫寻求医疗保健相关的因素及原因。
基于网络的“克服（美国）”调查研究在美国具有人口统计学代表性的样本中识别出患有活动性偏头痛的成年人，这些人回答了有关因偏头痛而犹豫寻求医疗服务提供者护理的问题以及犹豫的原因。监督式机器学习（随机森林、最小绝对收缩和选择算子）确定与犹豫相关的因素；逻辑回归模型评估因素与犹豫之间的关联。
研究结果表明，在完成“克服（美国）”基线调查并对因偏头痛而犹豫寻求护理的问题作出回答的58403名患有活动性偏头痛的参与者中，45.1%（n = 26330/58403）的偏头痛患者表示他们曾因偏头痛而犹豫寻求护理。与犹豫寻求护理最相关的因素是隐瞒偏头痛（优势比[OR] = 2.69；95%置信区间[CI]：2.50，2.89）、经历与偏头痛相关的污名（OR = 2.13；95% CI 1.95，2.33）、较高的与偏头痛相关的残疾（OR = 1.30；95% CI 1.23，1.38）以及较高的发作期皮肤异常性疼痛（OR = 1.26；95% CI 1.19，1.35）。参与者表示犹豫的最常见原因包括：（1）44.2%想要自行尝试处理偏头痛，（2）33.8%觉得他们的偏头痛或头痛不会被认真对待，（3）29.2%认为他们的偏头痛不够严重/疼痛程度不够，以及（4）27.4%负担不起或不想花钱。该研究的主要局限性包括要求受访者具备互联网接入，这可能反映了队列偏差，以及采用配额抽样而非随机抽样来创建具有人口统计学代表性的样本。
因偏头痛而犹豫寻求护理的情况很常见，并且与隐瞒疾病和与偏头痛相关的污名最为密切相关。那些经历较高偏头痛相关负担的人更不愿意寻求可能减轻负担的护理。这些发现表明，偏头痛的社会背景（例如污名）是犹豫寻求偏头痛护理的主要决定因素。
