Clinical Characteristics and Treatment Patterns among Patients with Diagnostic Codes for Cluster Headache in U.S. Healthcare Claims Data

Authors: Casey K. Choong, Janet H. Ford, Allen W. Nyhuis, Rebecca L. Robinson, Sheena Aurora and James M. Martinez
Source: Neurology, 18 April 2017, Vol. 88, No. 16, Supplement P1, 181


Objective: To characterize demographics, clinical characteristics, and treatment patterns of patients with cluster headache (CH).

Background: CH is a rare trigeminal autonomic cephalalgia with limited treatment options. Patients suffer from extremely painful unilateral headache attacks and autonomic symptoms with bouts that are episodic or chronic in nature.

Design/Methods: This retrospective observational study analyzed claims data from the Truven Health Analytics MarketScan® Research Databases from 2009–2014. Two cohorts were compared: propensity-score (PS) matched CH and non-headache control patients. Eligible CH patients had ≥2 CH claims. All patients had continuous enrollment for ±12 months from date of first CH claim. Descriptive comparisons are presented.

Results: PS-matched patients were identified: 7589 CH and 30341 non-headache control patients. CH patients were mainly male (57.4%) and 73.1% ranged from 35–64 years old. Several comorbid conditions were significantly higher in CH patients: depressive disorders (19.8 vs 10.0), sleep disturbance (19.7 vs 9.1), anxiety disorders (19.2 vs. 8.7), and tobacco use disorders (12.8 vs. 5.3), with 2.6 greater odds of suicidal ideation (all p<0.0001). Odds of drug dependence was 3-fold greater among CH patients (OR=2.8 [95% CI 2.3–3.4, p<0.0001]). CH patients reported significantly higher use of prescription medications compared with control patients; 25% of CH patients had >12 unique prescription drug claims. Most commonly prescribed drug classes for treatment of CH included: opiate agonists (41%), corticosteroids (34%), 5HT1 agonists (32%), antidepressants (31%), NSAIDs (29%), anticonvulsants (28%), calcium channel blockers (27%), and benzodiazepines (22%). Observed treatment patterns 12-months post the index diagnostic claims for CH showed 30% of the CH cohort was prescribed recommended CH treatments.

Conclusions: The burden of CH is associated with significant co-morbidity including substance use disorders and suicidal ideation, as well as treatment patterns indicating low use of recognized CH treatments.

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