Psychosocial factors and patient–provider interactions associated with procedural migraine care: A cohort of 23,163 patients from the NIH All of Us Research Program

Background Procedural therapies, including chemodenervation and nerve-targeted surgery, are increasingly used for refractory migraine. However, nonclinical factors associated with escalation to procedural care remain incompletely understood. Methods A retrospective cohort study was conducted using data from the National Institutes of Health All of Us (NIH AoU) Research Program Registered Tier dataset (version 8). Adults with a documented diagnosis of migraine were identified and classified based on receipt of procedural migraine treatment within 1 year of diagnosis. Patient-reported measures were derived from NIH AoU The Basics and Social Determinants of Health (SDOH) surveys, focusing on psychosocial stress, emotional well-being, and patient–provider interactions. Multivariable logistic regression was performed to estimate the adjusted odds ratios (ORs) for receipt of procedural migraine treatment, controlling for age, sex, and race. Results Among 23,163 adult patients, 458 (2.0%) received procedural migraine treatment within 1 year of diagnosis. In adjusted analyses, higher perceived psychosocial stress (OR, 1.48; 95% confidence interval [95% CI], 1.21–1.82), frequent emotional withdrawal (OR, 1.47; 95% CI, 1.10–1.95), and patient-reported negative patient–provider interactions (OR, 1.35; 95% CI, 1.09–1.69) were significantly associated with receipt of procedural migraine treatment. Demographic factors, including age, sex, and race, were not significantly associated with treatment utilization after adjustment. Conclusion Psychosocial distress and patient–provider interactions are associated with receipt of procedural migraine treatment, likely reflecting disease burden and care complexity rather than differential access. Leveraging the granularity of patient-reported survey data within the NIH AoU Research Program highlights the potential of next-generation datasets to advance patient-centered research in plastic and reconstructive surgery.