The Role of Income and Health Insurance on Migraine Care: Results of the OVERCOME (US) Study

Using data from the OVERCOME study, we examined the influence of household income on access to specialty care and use of recommended acute and preventive treatments for migraine in a large population-based study. This analysis from the OVERCOME study, a multicohort, web-based survey (2018–2020) among adults with migraine in the US, examined the influence of annual household income on (1) care-seeking, (2) the highest level of care received (emergency department/urgent care, primary care, specialty care), and (3) use of acute or preventive treatments recommended by the American Headache Society. We used standardized mean differences and logistic regression (LR) models to estimate the magnitude of differences in health care behavior as a function of household income and insurance status. Among OVERCOME (US) respondents with migraine who provided demographic information (n = 56,667), a higher proportion of people in the lowest income group (< $25,000) received their highest level of migraine care in the emergency department/urgent care setting versus the proportion in the highest income group [≥ $100,000: 12.3% vs 6.5%, standardized mean difference (SMD) = 0.20], and a greater proportion in the highest income group received care in a specialty headache care setting (48.6% vs 36.6% in the lowest income group, SMD = 0.24). The highest income group was more likely to receive a recommended acute treatment [odds ratio (OR) = 1.3, 95% confidence interval (CI) = (1.2, 1.4)] and a recommended preventive treatment [OR = 1.3, 95% CI = (1.2, 1.4)]. Those with health insurance were more likely to receive specialized care [OR = 2.6, 95% CI = (2.4, 2.8)] and recommended acute [OR = 1.9, 95% CI = (1.8, 2.0)] and preventive treatment [OR = 2.1, 95% CI = (1.9, 2.3)]. The effect of insurance was greatest in low-income strata and was not significant in the highest household income group. Disparities in annual household income may be a barrier to appropriate migraine care, but having health insurance mitigates the effect. This report examines how household income and health insurance influence where people living with migraine seek care (emergency department/urgent care, primary care, specialist doctors) and their use of recommended acute and/or preventive treatments. Data reported herein were generated from the OVERCOME (USA) study, a web-based survey run annually from 2018 to 2020, which assessed the participants’ demographics, migraine experiences, migraine-related burden, disability, and patterns of health care-seeking and treatment. A total of 56,667 participants with migraine were included in this analysis; 1489 participants did not report income, and the remaining reported annual household income in one of the following five categories: < $25,000, $25,000–$49,999, $50,000–$74,999, $75,000–$99,999, and ≥ $100,000. More people in the lowest income group received care for their migraine in the emergency/urgent care setting than those in the highest income group. Those with higher incomes were more likely to receive care from a specialist and to use recommended acute and preventive migraine treatments. For participants in the lower income groups, health insurance was important for access to specialist doctors and recommended migraine treatments. We conclude that lower household income is a potential barrier to seeking medical care for migraine and obtaining treatment. Having health insurance can reduce the impact of low household income on the likelihood of accessing care. The results further highlight the need for public health policies that reduce these barriers, such as expanding eligibility and coverage for public insurance options including Medicaid and Medicare, and making specialist treatment and recommended medications easier to access.