Robert Cowan, MD, on Sex and Race Disparities in Migraine Patients
Subgroup disparities such as sex and race are more significant among patients with migraine, according to the results of a recent study presented at the American Academy of Neurology (AAN) 2021 Virtual Meeting.
The researchers utilized data from an annual cross-sectional patient chart audit of 1003 patients who were recently prescribed a calcitonin gene-related peptide monoclonal antibody or onabotulinumtoxinA. Subgroups were defined as man or woman for sex and White or minority for race.
An analysis was conducted of these subgroups, examining the age of first migraine episode and diagnosis; use of a migraine specialist; insurance coverage; type of migraine; comorbid hypertension, depression, or anxiety; and success of previous preventive therapies. Further, the researchers accounted for factors that affected therapy selection, such as patient request, efficacy onset speed expectation, family planning consideration, and nonadherence concern.
To learn more about the results of this study, Consultant360 reached out to study author and AAN session presenter Robert Cowan, MD. Dr Cowan is a professor of neurology and chief of the Division of Headache Medicine at Stanford University.
Consultant360: To begin, could you discuss what prompted this study?
Robert Cowan: I am a big believer in data-driven studies. That is not to say that the old paradigm of hypothesis-driven investigations has outlived their usefulness, but technology has given us an opportunity to collect large amounts of data and perform analytics to better understand the characteristics of a given population. I have worked with Spherix for several years now on projects that do exactly that. We do not set out to “prove” any hypothesis, rather we collect data, then try to understand it. It does not eliminate investigator bias because we still choose what questions to ask, but it greatly reduces it.
C360: Your study found that not only do disparities exist in subpopulations with migraine, but they are even more significant than those that are recognized in the general population. Is this a result that surprised you, or did you anticipate this?
RC: We did not know what the data would show. But am I surprised to find that disparities that exist in the general population exist and are exaggerated in traditionally marginalized populations? Hardly.
C360: According to your study, more women were diagnosed with chronic migraine while more men were diagnosed with low-frequency episodic migraine. What is the importance of this finding?
RC: Of course, the easy answer is sociologic—women tend to suffer in pain, and men are big babies. But saying that could get me into big trouble, so I think the more politically correct (and probably more accurate) interpretation is that we do not know. Estrogen? Sample bias? There could be lots of factors, and cultural influences could play a role. I think this is an example of how data-driven studies can generate interesting hypotheses that can then be tested.
C360: Your study notes that patient request, efficacy onset speed expectation, family planning consideration, and nonadherence concerns were among the factors that influenced therapy selection among minority patients. How will this knowledge impact future migraine care for minority patients?
RC: This underscores issues that are of critical importance in patient care: Who are the patients who come to see health care providers (and who are those that do not), and why?
This gives us real insight into focus of control issues and the opportunities that exist for education. Family planning considerations should remind us that the patient with migraine does not exist in a vacuum made of pain, nausea, and sensoriphobias but that this disease affects entire families, businesses, and social relationships. This in turn reflects issues of compliance and adherence. Too often, we think our job is done when we lay out the plan. Buy in and adherence are 2 different animals, and we need to consider both when we work with patients.
C360: What are the next steps for research in this area?
RC: Spherix and its advisors—myself included—refine the questions and focus of data collection based on what we learn. We will continue to use this approach to help us better understand differences among subpopulations within the migraine space. Hopefully others will look at this data and ask questions, generate hypotheses, and design studies to find the answers as well.
Cowan R, Stabb M, Robinson N, Schobel V. Understanding the impact of sex and race on the migraine patient’s journey in the United States: analyses from an annual cross-sectional patient chart audit. Paper presented at: American Academy of Neurology’s 2021 Virtual Annual Meeting; April 17-22, 2021; Virtual. https://index.mirasmart.com/AAN2021/PDFfiles/AAN2021-002115.html