Among People With Obesity, Migraine Comorbidity Increases Healthcare Utilization, Costs

The risk of migraine is heightened among people with obesity, and obesity may also contribute to migraine chronicity. The 2 conditions independently add personal and societal burden, diminish quality of life, and increase healthcare utilization. Paired together, the burden is magnified, according to a new study that found that among people with obesity, those with migraine had greater total healthcare utilization and expenses compared with those without migraine.

Estimated healthcare costs among people with obesity range from $147 billion to $210 billion per year, and people with moderate to severe obesity are 1.84 to 4.0 times more likely to be prescribed medications. Meanwhile, migraine is underdiagnosed and undertreated in the United States, and direct costs associated with migraine are estimated at more than $11 billion per year.

Using 2006 to 2013 data from the Household Component of the Medical Expenditure Panel Survey, researchers collected information on 23,596 people with obesity, including sociodemographic characteristics, medical conditions and health status, healthcare utilization, medical care and prescription drug expenses, and insurance coverage. The survey also contacted each participant's medical provider, health system, and pharmacy to validate and get more detailed information.

Among the participants, 1025 (4.7%) reported having migraine. According to the researchers, this rate is much lower than migraine burden in the obese population (20% to 25%) and in the general population (12% to 16%), suggesting that most people with migraine do not consult with physicians. Compared with people with obesity without migraine, those with obesity and migraine were younger, more likely to be female, and had poorer perceived health status.

Participants who had migraine had more visits to the physician’s office and emergency department, as well as more prescription medications. However, just 25% were prescribed antimigraine medications, and migraine-related expenses accounted for approximately 5% of total healthcare expenses.

According to the researchers, it was medical care utilization, rather than prescribed medications, that was the driver behind higher total medical expenses in participants with migraine. They explained, “This study’s health services utilization results imply that the ambulatory care setting where primary care providers treat headache may be a good place to assess the impact of interventions targeting comorbidities on migraine occurrence in obese adults.”

Participants with migraine had total health expenses that were $2213 greater than those without migraine, with medical expenses being $1401 greater and prescription drug expenses being $813 greater. After adjusting for sociodemographic and health-related variable, total health expenses increased by 31.6% among participants with migraine.

The researchers noted that there was no significant difference in the frequency and expense of hospitalization between the 2 groups.

They also observed that as obesity severity increased, so did healthcare costs for participants with migraine. Total health expenses for people with severe obesity totaled $10,506, while expenses totaled $8302 for participants with obesity and $7333 for patients with overweight.

Reference:

Wu J, Davis-Ajami M, Lu Z. Impact of migraine on health care utilization and expenses in obese adults: a US population-based study [published online December 31, 2018]. doi: 10.2147/CEOR.S189699.