1. The migraine signature study: Methods and baseline results
- Author
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Christine Szekely, Dawn C. Buse, Victoria M. Chia, Alice R. Pressman, Alexandra B. Scott, Richard B. Lipton, Walter F. Stewart, Alice Jacobson, and Shruti Vaidya
- Subjects
Adult ,Male ,medicine.medical_specialty ,Neurology ,Adolescent ,Migraine Disorders ,Triptans ,Research Submissions ,Comorbidity ,California ,03 medical and health sciences ,primary care ,Young Adult ,0302 clinical medicine ,Internal medicine ,medicine ,Electronic Health Records ,Humans ,migraine ,030212 general & internal medicine ,Neurologists ,Medical prescription ,Aged ,Retrospective Studies ,Aged, 80 and over ,health care system ,Primary Health Care ,business.industry ,Delivery of Health Care, Integrated ,neurology ,Retrospective cohort study ,electronic health record ,Middle Aged ,medicine.disease ,Migraine ,Cohort ,Female ,Neurology (clinical) ,Diagnosis code ,business ,headache ,030217 neurology & neurosurgery ,Facilities and Services Utilization ,medicine.drug - Abstract
Objective To characterize patients who utilize services for migraine in a large integrated health care network, and describe patterns of care and utilization. Background Within health care systems, migraine is a common reason for seeking primary and neurology care, but relatively little is documented about who seeks care and the factors that explain variation in utilization. Methods We conducted a retrospective cohort study using electronic health record (EHR) data from Sutter Health primary care (PC) patients who had at least one office visit to a PC clinic between 2013 and 2017. Migraine status was ascertained from diagnosis codes and medication orders. Control status was assigned to those with no evidence of care for any type of headache. We divided the primary care migraine cohort into two groups: those who received all their care for migraine from PC (denoted PC‐M) and those who had ≥1 encounter with a neurologist for migraine (denoted N‐M). Migraine cases were also designated as having preexisting migraine if they had an encounter with a migraine diagnosis within (±) 6 months of their first study period PC visit and, otherwise, designated as first migraine consult. Two levels of contrasts included: patients with migraine and controls; and within the group of patients with migraine, PC‐M and N‐M groups. Comorbid conditions were determined from EHR encounter diagnosis codes. Results We identified 94,149 patients with migraine (including 21,525 N‐M and 72,624 PC‐M) and 1,248,763 controls. Comorbidities: Proportions of psychiatric [29.8% (n = 28,054) vs. 11.8% (n = 147,043)], autoimmune [(4.4% (n = 4162) vs. 2.6% (n = 31,981)], pain [13.2% (n = 12,439) vs. 5.8% (n = 72,049)], respiratory [24.6% (n = 23,186) vs. 12.3% (n = 153,692)], neurologic [2.9% (n = 2688) vs. 0.9% (n = 11,321)], and cerebrovascular [1.0% (n = 945) vs. 0.6% (n = 7500)] conditions were higher in the migraine group compared to controls, all p
- Published
- 2020