Migraine Care Challenges and Strategies in US Uninsured and Underinsured Adults: A Narrative Review, Part 2

Charleston, Larry; Royce, Jeffrey; Monteith, Teshamae; Broner, Susan W.; O’Brien, Hope L.; Manrriquez, Salvador L.; Robbins, Matthew S.

doi:10.1111/head.13321

Cited by 11 publications

(7 citation statements)

References 102 publications

(182 reference statements)

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“…20 Latino patients are less likely to receive clinically significant high-quality prophylactic headache medications in US ambulatory care. 7,8…”

Section: Methodsmentioning

confidence: 99%

“…African American men receive the least care for headache diseases nationwide, 6 and are less likely than White patients to present for ambulatory care for migraine disorders. 7,8 African American patients visiting emergency departments (EDs) with headache were 4.8 times less likely than White patients presenting with the same complaint to receive CT to diagnose the etiology of their headache. 9 Similarly, in a prospective study on headache in the ED, White children were 3 times more likely to receive imaging compared to children of other races.…”

Section: Methodsmentioning

confidence: 99%

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Factors Associated With, and Mitigation Strategies for, Health Care Disparities Faced by Patients With Headache Disorders

et al. 2021

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ObjectiveTo review the contemporary issues of healthcare disparities in Headache Medicine with regard to race/ethnicity, socioeconomic status and geography and propose solutions for addressing these disparities.MethodsAn internet and PubMed search was performed and literature was reviewed for key concepts underpinning disparities in Headache Medicine. Content was refined to areas most salient to our goal of informing the provision of equitable care in headache treatment through discussions with this group of 16 experts from a range of headache subspecialties.ResultsTaken together, a multitude of factors including racism, socioeconomic status and insurance status and geographical disparities contribute to the inequities that exist within the healthcare system when treating headache disorders. Interventions such as improving public education, advocacy, optimizing telemedicine, engaging in community outreach to educate primary care providers, training providers in cultural sensitivity and competence and implicit bias, addressing health literacy and developing recruitment strategies to increase representation of underserved groups within headache research are proposed as solutions to ameliorate disparities.ConclusionNeurologists have a responsibility to provide and deliver equitable care to all. It is important that disparities in the management of headache disorders are identified and addressed.

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“…20 Latino patients are less likely to receive clinically significant high-quality prophylactic headache medications in US ambulatory care. 7,8…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Factors Associated With, and Mitigation Strategies for, Health Care Disparities Faced by Patients With Headache Disorders

et al. 2021

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“…This is a concern, especially because the prevalence of migraine is greater among individuals in lower versus higher income groups 2,7 . Plausible solutions and strategies to migraine care in underinsured and uninsured adults have been described 45,46 …”

Section: Discussionmentioning

confidence: 99%

Barriers to care in episodic and chronic migraine: Results from the Chronic Migraine Epidemiology and Outcomes Study

et al. 2021

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Objective: To assess rates of and factors associated with traversing fundamental barriers to good medical outcomes and pharmacologic care in individuals with episodic migraine (EM) and chronic migraine (CM), including socioeconomic status and race.Background: Barriers to good outcomes in migraine include the lack of appropriate medical consultation, failure to receive an accurate diagnosis, not being offered a regimen with acute and preventive pharmacologic treatments (if indicated), and not avoiding medication overuse. Methods: The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study was a longitudinal Internet-based survey. Respondents who met criteria for migraine consistent with the International Classification of Headache Disorders, 3rd edition, had a Migraine Disability Assessment score ≥ 6, and provided health insurance coverage status were included in this analysis. Successfully traversing each barrier to care and the effects of sociodemographic characteristics were examined. Results: Among 16,789 respondents with migraine, 9184 (54.7%; EM: 7930; CM: 1254) were eligible. Current headache consultation was reported by 27.6% (2187/7930) of EM and 40.8% (512/1254) of CM respondents. Among consulters, 75.7% (1655/2187) with EM and 32.8% (168/512) with CM were accurately diagnosed. Among diagnosed consulters, 59.9% (992/1655) with EM and 54.2% (91/168) with CM reported minimally appropriate acute and preventive pharmacologic treatment. Among diagnosed and treated consulters, in the EM group 31.8% (315/992) and in the CM group 74.7% (68/91) met medication overuse criteria. Only 8.5% (677/7930) of EM and 1.8% (23/1254) of CM respondents traversed all four barriers. Higher income was positively associated with likelihood of traversing each barrier. Blacks and/orAfrican Americans had higher rates of consultation than other racial groups. Blacks and/or African Americans and multiracial people had higher rates of acute medication overuse.

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“…This article presents important points for consideration to facilitate participation of underserved groups in headache medicine research in the hope for more inclusive and accurate research and, as a result, improved patient care and reduced health‐care disparities. Research that focuses on understanding the underlying causal pathways for health disparities in headache medicine is necessary to develop interventions to address those issues 7 …”

Section: Discussionmentioning

confidence: 99%

“…Black Americans are less likely to be diagnosed with migraine, in part because they are less likely to endorse full criteria for migraine, and are also less likely to access the medical system for treatment 3,5 . Black men receive the least care for headache diseases nationwide and are less likely to present for ambulatory care for migraine compared with Whites 6,7 . Black patients are less likely to be given pain medications than White patients despite similar self‐reports of pain 8‐10 .…”

Section: Introductionmentioning

confidence: 99%

Ten Eleven things to facilitate participation of underrepresented groups in headache medicine research

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Headache is a leading reason for medical consultation and yet remains underdiagnosed. 1 Headache diseases are highly prevalent and disabling. Migraine alone affects 1 billion people and is the second leading cause of disability worldwide. 2 There still remains a dearth of information surrounding how the headache diseases affect underserved populations and most importantly how this can be addressed. Migraine prevalence studies based in the United States indicate that the prevalence is highest in Native Americans, followed by White Americans, Black Americans, Hispanics, and Asian-Americans. 3,4 Black Americans are less likely to be diagnosed with migraine, in part because they are less likely to endorse full criteria for migraine, and are also less likely to access the medical system for treatment. 3,5 Black men receive the least care for headache diseases nationwide and are less likely to present for ambulatory care for migraine compared with Whites. 6,7 Black patients are less likely to be given pain medications than White patients despite similar self-reports of pain. 8-10 To our knowledge, there are no examples of headache researchers addressing the challenges to inclusion of diverse populations in headache clinical trials. The authors are aware of only three research studies published that specifically examined for racial health disparities in headache medicine. [11][12][13] These studies could be classified as first-generation health disparity research. 14,15

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Migraine Care Challenges and Strategies in US Uninsured and Underinsured Adults: A Narrative Review, Part 2

Cited by 11 publications

References 102 publications

Factors Associated With, and Mitigation Strategies for, Health Care Disparities Faced by Patients With Headache Disorders

Factors Associated With, and Mitigation Strategies for, Health Care Disparities Faced by Patients With Headache Disorders

Barriers to care in episodic and chronic migraine: Results from the Chronic Migraine Epidemiology and Outcomes Study

Ten Eleven things to facilitate participation of underrepresented groups in headache medicine research

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