The economic burden of pain in migraine: a national study of U.S. healthcare expenditures.

BACKGROUND: Migraine is a prevalent and disabling neurological disorder associated with substantial healthcare costs. Coexisting pain is frequently reported among individuals with migraine and may significantly exacerbate both clinical burden and healthcare expenditures. However, limited research has quantified the specific contribution of pain to excess healthcare costs in this population. METHODS: We conducted a cross-sectional analysis using 2019-2022 data from the Medical Expenditure Panel Survey (MEPS) to examine the impact of pain on healthcare expenditures among U.S. adults with migraine. Pain was identified using a self-reported measure of pain interference with daily activities. Individuals were categorized into two groups: migraine with pain and migraine only (without pain). Generalized linear models (GLMs) were used to estimate adjusted healthcare costs, and Blinder-Oaxaca decomposition was applied to assess the extent to which observed cost differences were attributable to patient characteristics. RESULTS: Among 1,411 adults with migraine, 66% reported pain that interfered with daily function. Individuals with migraine and pain incurred significantly higher total healthcare expenditures than those without pain ($18,748 vs. $10,042; p < 0.0001), with outpatient services being the main cost drivers. After adjustment, pain remained significantly associated with higher costs, particularly in outpatient care (incremental cost: $4,546; p < 0.0001). Decomposition analysis showed that 76% of the cost difference was explained by observed characteristics, primarily poorer perceived health, unemployment, and comorbid arthritis. CONCLUSION: Pain substantially increases the economic burden of migraine, largely through elevated outpatient care costs. These findings highlight the need for comprehensive pain assessment and integrated care strategies to manage pain in individuals with migraine and reduce healthcare expenditures.