Do patients with migraine and obesity receive different treatments? Insights from real-world data.

BACKGROUND

Patients with obesity often experience stigma in healthcare, which may lead to underdiagnosis or undertreatment. In the context of pain management, and migraine specifically, patients with obesity are more likely to receive both opioid and non-opioid analgesics. However, little is known about their use of preventive treatments.

METHODS

We conducted a large retrospective cohort study using propensity score matching for sex and age, utilizing data from the Clalit Health Services database in Israel. The study compared newly diagnosed patients with migraine with and without obesity, identified between June 2020 and June 2023. The comparison focused on prescriptions for migraine-specific acute medication (triptans) and preventive migraine treatments.

RESULTS

Our final analysis included 11,934 patients with migraine and obesity and 11,934 without obesity. Patients with obesity were more likely to have cardiovascular risk factors and psychiatric comorbidities. Patients with obesity were also more likely to receive acute treatment with triptans (adjusted odds ratio [aOR] 1.17, 95% confidence interval [CI] [1.11-1.23]), and preventive treatments such as topiramate (aOR 1.66, 95% CI [1.38-1.99]), gabapentinoids (aOR 1.30, 95% CI [1.13-1.50]), and duloxetine (aOR 1.42, 95% CI [1.18-1.70]), adjusting for comorbidities.

CONCLUSION

Our findings do not support the notion that patient with migraine and obesity are undertreated; instead, they show a modest increase in prescriptions for acute and some of the preventive medications.