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Finding Good Migraine Care a Headache for the Uninsured

They are twice as likely to resort to ERs for help rather than a doctor's office, study finds

MONDAY, April 12 (HealthDay News) -- People who are uninsured or who are on Medicaid are much less likely to receive adequate care for their migraines than people who have private coverage.

In fact, more than 5.5 million Americans may be at risk of receiving inadequate care for their migraines because of their insurance status, a new study suggests.

"Left untreated or undertreated, as a result of being uninsured, will cause millions of Americans with migraine to suffer needlessly and place them at greater risk for developing more frequent migraine headaches," said Dr. Brian M. Grosberg, director of the Inpatient Headache Program at Montefiore Medical Center and assistant professor of neurology at Albert Einstein College of Medicine in New York City. He was not involved in the study.

The lag in care may stem from the fact that the uninsured tend to seek care at hospital emergency rooms rather than a doctors' office, according to findings published in the April 13 issue of Neurology.

"This study is really about the need to improve the healthcare system so everybody has access to a physician in an office so they don't have to go to an emergency department -- where we know they're not going to get the best treatment," added the study's senior author, Dr. Rachel Nardin, chair of neurology at Cambridge Health Alliance and assistant professor of neurology at Harvard Medical School in Boston.

"It's a sad situation because we actually have pretty good treatments that can help a lot of people, but what we don't have is a functioning healthcare system that allows us to get treatment to people who need it," continued Nardin, who is also chair of the Massachusetts chapter of Physicians for a National Health Program.

According to background information in the article, some 18 percent of women and 6 percent of men suffer from migraines.

"Migraines are a whole-system disease. People with migraines are really out of commission," Nardin said. "They have to lie down and sleep for several hours. People with migraines lose an average of four days of work a year, and that doesn't include the toll it takes on them as productive members of their family or church."

Meanwhile, more than 45 million Americans have no health insurance at all, and an additional 58 million are underinsured, according to the latest federal data from the National Center for Health Statistics.

In the study, researchers looked at results from two surveys on visits to doctors' offices, hospital outpatient visits and trips to the emergency room over a period of 11 years.

They estimated a total of 68.6 million such visits nationally during that time period for migraine complaints.

People with no insurance were twice as likely to receive inadequate therapy, either to treat or prevent migraines, as those with private coverage. Those with Medicaid were 50 percent more likely.

If migraine care was received in an emergency room, uninsured and Medicaid patients were almost five times more likely to receive inadequate care for their migraine.

"Migraine can be treated very effectively in a physician's office," Nardin said. "We all suffer when people need to use the emergency room because it then becomes less available for true emergencies. Migraines are a great example of where the system is not set up to get the right care in the right place at the right time. If we could do that, we would all benefit."

More information

Find out more at the National Migraine Association.

SOURCES: Rachel Nardin, M.D., chair, division of neurology, Cambridge Health Alliance, assistant professor, neurology, Harvard Medical School, Boston, and chair, Massachusetts chapter, Physicians for a National Health Program; Brian M. Grosberg, M.D., assistant professor, neurology, Albert Einstein College of Medicine and director, Inpatient Headache Program, Montefiore Headache Center, New York City; April 13, 2010, Neurology

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