Uninsured, Medicaid patients receive poor migraine care

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© Ghislain & Marie David de Lossy/cultura/Corbis

The uninsured and those whose primary health insurance is through Medicaid are far more likely to receive poor migraine treatment, compared with people who have private health insurance, according to a study published in the journal Neurology. Analyzing data from two large national surveys of patient visits to hospitals and doctor’s offices, researchers focused on 6,814 visits for migraine between 1997 and 2007. Based on the American Academy of Neurology’s definition of optimal migraine treatment, which generally includes the administration of migraine medications such as dihydroergotamine sumatriptan, Harvard neurologist Dr. Rachel Nardin and colleagues found that patients who had no health insurance were twice as likely to receive substandard migraine treatment, and that those who had Medicaid—the federal health insurance plan for low-income families and individuals—were 50% more likely to get poor quality care.

In part, the study authors say, the discrepancy between private insurance holders and those without health insurance or with Medicaid can be attributed to where they sought treatment. Both the federally insured and uninsured were more likely to seek treatment in emergency rooms instead of doctor’s offices, where, according to the study, only 20% received appropriate treatment for acute migraine and 10% received optimal preventive care. Still, point of care alone doesn’t completely account for the broad gap in care, researchers conclude.

Migraine headaches are generally characterized by a sensation of intense pain isolated to a specific region of the brain and can be accompanied by sensitivity to light and sound, nausea and vomiting. An estimated 12% of the U.S. population suffers from migraines, and the debilitating headaches are three times more common among women compared with men. Based on the findings of this study, Nardin and colleagues suggest that as many as 5.5 million Americans may receive inadequate migraine care each year, leading to unnecessary pain and suffering.

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