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Abstract Details

Epidemiology and Equity of Acute Migraine Care Among VHA Enrolled Veterans
Headache
P9 - Poster Session 9 (5:00 PM-6:00 PM)
15-004

To describe VHA-based treatment of acute migraine among veterans.

Acute migraine treatments include over the counter and prescription medications. Calcitonin gene-related peptide (CGRP) receptor antagonists (gepants) are a newer treatment option. Few studies have described real-world prescribing, particularly for gepants, and updated data are needed to assess their use.

We conducted a retrospective cross-sectional study using VHA administrative data, including veterans with a migraine-related visit in FY2024, and followed them through available FY25 data to assess prescriptions of triptans, gepants, or ergotamines, and a composite of any of the three. Multivariable logistic regression models assessed associations between sociodemographic factors and prescribing. Results are presented as adjusted odds ratios with 95% confidence intervals.

Among 376,030 veterans, 43.0% were prescribed any acute migraine medication, most commonly triptans (39.3%), followed by gepants (5.7%), or ergotamines (<1%). Black, Asian, and Pacific Islander veterans had greater odds of any prescription (aORs = 1.19-1.28) or a triptan (aORs = 1.21-1.37), but lower odds of gepants (aORs = 0.70-0.83) compared to White veterans. Older age (continuous) was associated with lower odds of any prescription (aOR = 0.98; 0.98–0.98) and triptans (aOR = 0.98; 0.98-0.98), but higher odds of gepants (aOR = 1.01; 1.01–1.01). Age-race interactions showed Black veterans ≥65 had higher odds of any prescription compared to White veterans ≥65 (aOR = 1.17; 1.11–1.23). Female veterans had lower odds of any prescription (aOR = 0.89; 0.88–0.91) and triptans (aOR = 0.82, 0.81–0.83), but higher odds of gepants (aOR = 1.69; 1.64–1.74). Rural residence was associated with lower odds of any prescription (aOR = 0.93; 0.92, 0.94) and triptans (aOR=0.92; 0.91, 0.93). Highly rural residence was associated with lower prescriptions across all outcomes (aORs = 0.78-0.88).

Acute migraine medication prescribing in the VHA varied by sociodemographic factors, highlighting access disparities.

Authors/Disclosures
Elinor Laffargue, MPH
PRESENTER 		Miss Laffargue has nothing to disclose.
HARINI BATHULAPALLI, MPH Ms. BATHULAPALLI has nothing to disclose.
John Ney, MD, MPH, FAAN (VA Connecticut) Dr. Ney has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Ceribell. Dr. Ney has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology Clinical Practice.
daniel rogers, PhD Dr. rogers has nothing to disclose.
Elizabeth Seng, PhD (Yeshiva University, Albert Einstein College of Medicine) Dr. Seng has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Abbvie. Dr. Seng has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Theranica. Dr. Seng has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pfizer. The institution of Dr. Seng has received research support from NCCIH. Dr. Seng has received research support from Cystic Fibrosis Foundation. The institution of Dr. Seng has received research support from American Heart Association.
Allison Wright Willis, MD (University of Pennsylvania) Dr. Wright Willis has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Pharmacoepidemiology and Drug Safety. Dr. Wright Willis has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. The institution of Dr. Wright Willis has received research support from NIH. The institution of Dr. Wright Willis has received research support from NIA. The institution of Dr. Wright Willis has received research support from Biogen. The institution of Dr. Wright Willis has received research support from Parkinson Foundation. The institution of Dr. Wright Willis has received research support from Arcadia.