Abstract
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.
Study Supported by:
Study supported by Eli Lilly and Company
Disclosure: Dr. Choong has received research support for activities with Eli Lilly and Company as an employee. Dr. Choong holds stock and/or stock options in Eli Lilly and Company. Dr. Ford has received personal compensation for activities with Eli Lilly and Company as an employee. Dr. Nyhus has received personal compensation for Eli Lilly and Company. Dr. Nyhus holds stock and stock/options in Eli Lilly and Company. Dr. Robinson has received personal compensation for activities with Eli Lilly as an employee. Dr. Robinson holds stock and/or stock option in Eli Lilly. Dr. Aurora has received personal compensation for activities with Eli Lilly and Company as an employee and Allergan as a consultant. Dr. Aurora hold stock and/or stock options in Lilly and Company. Dr. Martinez has received personal compensation for activities with Eli Lilly and Company as an employee. Dr. Martinez holds stock and/or stock options in Eli Lilly and Company.
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