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Articles
April 12, 2010

Impact of insurance status on migraine care in the United States
A population-based study

April 13, 2010 issue
74 (15) 1178-1183

Abstract

Objective: To determine whether insurance status is associated with differential outpatient treatment of migraine in the United States.
Methods: We analyzed 11 years of data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (1997–2007), which survey patient visits to doctors' offices, hospital outpatient departments, and emergency departments (EDs) in the United States. We used logistic regression to determine whether insurance status was associated with the prescription of standard migraine therapy, defined as 1) a triptan or dihydroergotamine and 2) a prophylactic agent.
Results: We identified 6,814 individual patient visits for migraine, representing 68.6 million visits nationally. After controlling for age, gender, race/ethnicity, geographic location, and year, migraineurs with no insurance or Medicaid were less likely than the privately insured to receive abortive therapy (odds ratio [OR] for failure to receive medication 2.0 [95% confidence interval (CI) 1.3, 3.0] and 1.6 [95% CI 1.1, 2.3]) and prophylactic therapy (OR 2.0 [95% CI 1.3, 2.9] and 1.5 [95% CI 1.0, 2.1]). Adding site of care to the regression model suggested that one mechanism for this discrepancy was the reliance of the uninsured on EDs for migraine care, a site where standard migraine care is often omitted (OR for failure to receive abortive and prophylactic medication in the ED relative to physicians' offices 4.8 [95% CI 3.6, 6.3] and 8.7 [95% CI 6.4, 11.7]).
Conclusions: The uninsured, and those with Medicaid, receive substandard therapy for migraine, at least in part because they receive more care in emergency departments and less in physicians' offices.

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Information & Authors

Information

Published In

Neurology®
Volume 74Number 15April 13, 2010
Pages: 1178-1183
PubMed: 20385889

Publication History

Published online: April 12, 2010
Published in print: April 13, 2010

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Notes

Authors

Affiliations & Disclosures

Andrew Wilper, MD, MPH
From the Department of Veterans Affairs (A.W.), Boise VA Medical Center, University of Washington School of Medicine, Seattle; and Cambridge Hospital (S.W., D.H., R.N.), Harvard Medical School, Cambridge, MA.
Steffie Woolhandler, MD, MPH
From the Department of Veterans Affairs (A.W.), Boise VA Medical Center, University of Washington School of Medicine, Seattle; and Cambridge Hospital (S.W., D.H., R.N.), Harvard Medical School, Cambridge, MA.
David Himmelstein, MD
From the Department of Veterans Affairs (A.W.), Boise VA Medical Center, University of Washington School of Medicine, Seattle; and Cambridge Hospital (S.W., D.H., R.N.), Harvard Medical School, Cambridge, MA.
Rachel Nardin, MD
From the Department of Veterans Affairs (A.W.), Boise VA Medical Center, University of Washington School of Medicine, Seattle; and Cambridge Hospital (S.W., D.H., R.N.), Harvard Medical School, Cambridge, MA.

Notes

Address correspondence and reprint requests to Dr. Rachel Nardin, 1493 Cambridge St., Macht 420, Cambridge, MA 02139 [email protected]

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  2. Rural disparities in emergency department utilization for migraine care, Headache: The Journal of Head and Face Pain, (2023).https://doi.org/10.1111/head.14659
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  3. Association between Migraine and Quality of Life, Mental Health, Sleeping Disorders, and Health Care Utilization Among Older African American Adults, Journal of Racial and Ethnic Health Disparities, (2023).https://doi.org/10.1007/s40615-023-01629-y
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  9. Unique Considerations for Special Populations in Episodic Migraine: the Underserved, Current Pain and Headache Reports, 23, 2, (2019).https://doi.org/10.1007/s11916-019-0749-1
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  10. Migraine Care Challenges and Strategies in US Uninsured and Underinsured Adults: A Narrative Review, Part 1, Headache: The Journal of Head and Face Pain, 58, 4, (506-511), (2018).https://doi.org/10.1111/head.13286
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