OBJECTIVES: Evaluate healthcare resource utilization (HRU) and indirect costs among individuals with migraine and preventive treatment failure in France, Germany, Italy, Spain (EU4), and United Kingdom (UK) based on headache frequency and prior migraine preventive medication failure.

METHODS: A retrospective, cross-sectional analysis of National Health and Wellness Survey (NHWS) data from 2020. Adults in the EU4 and UK with self-reported physician-diagnosed migraine were identified using an opt-in online survey. Participants with ≥4 monthly headache days (MHDs) were stratified by preventive treatment use/failure (preventive failure: self-reported nonresponse to treatment) history (preventive naive; 0-1 failure [0 failure: preventive use without failure]; ≥2 failures). Multivariate analyses were performed to compare HRU, Work Productivity and Activity Impairment (WPAI) subscales, and indirect costs between groups.

RESULTS: The NHWS identified 1106 individuals with ≥4 MHDs (≥2 failures, n=298; 0-1 failure, n=308; preventive naive, n=500). Compared with ≥2 failures, preventive naive individuals were more likely to be older, treated by general practitioners, have lower Charlson Comorbidity Index scores, and have longer time since diagnoses. Absenteeism (OR: 0.67; 95% CI: 0.52, 0.86; P=0.002), overall work (OR: 0.80; 95% CI; 0.69, 0.94; P=0.005), and activity impairment (OR: 0.88; 95% CI: 0.80, 0.98; P=0.015) measured by WPAI were significantly lower in the preventive naive vs ≥2 failures group. Emergency department visits (OR: 0.65; 95% CI: 0.51, 0.83; P=0.001) and hospitalizations (OR: 0.53; 95% CI: 0.38, 0.74; P<0.001) in the last 6 months were significantly lower in the preventive naive vs ≥2 failures group. The proportion of individuals with non-adherence in the past 7 days (64% vs 73%) and indirect costs (€11,282 vs €13,720) were numerically lower in the preventive naive vs ≥2 failures group.

CONCLUSIONS: Individuals with migraine and ≥2 preventive failures demonstrated incremental economic burden compared with preventive naive individuals, highlighting the need for effective preventive treatment of migraine.