Migraine Care Challenges and Strategies in US Uninsured and Underinsured Adults: A Narrative Review, Part 1

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

doi:10.1111/head.13286

Cited by 22 publications

(21 citation statements)

References 29 publications

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“…7 In both incidence and severity, people occupying marginalized social locations (SL) bear the greatest migraine burden. 12–14 SL is a dynamic position on the social hierarchy determined by the ways intersecting socially ascribed identities are valued within shifting social, political, and economic contexts: racialized populations, people with less education, living in poverty, un- or underemployed, and those with high levels of chronic stress due to the unequal distribution of health-damaging experiences, for example, lack of clean and reliable food sources, unstable housing, prejudice and discrimination, and exposure to violence. 15,16…”

Section: Migraine: Incidence Burden and Caim Usementioning

confidence: 99%

Nonpharmacological Self-Management of Migraine Across Social Locations: An Equity-Oriented, Qualitative Analysis

Befus

Hull

Oliveira

et al. 2019

Glob Adv Health Med

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Background: Migraine is a disabling neurological disorder and the sixth biggest cause of disability worldwide. The World Health Organization has declared migraine a major public health problem due to a paucity of knowledge about cause and effective treatment options. Both in incidence and severity, migraine disproportionately affects people occupying marginalized social locations (SL). Managed pharmacologically, migraine is treated with daily preventive and as-needed abortive medications. Both come with high literal and figurative costs: intolerable side effects, medication interactions, and prohibitive prices. Cost prohibitive, ineffective, and unsustainable pharmacological treatment options have contributed to high levels of interest in complementary approaches by people with migraine, but little is known about their motivations, patterns of use or access, or how these may vary by SL. Method: We conducted focus groups with 30 people with migraine to explore their desires and recommendations for migraine clinicians and researchers. We used qualitative content analysis to identify themes. Outcomes: We identified 4 themes: a more holistic, collaborative, long-term treatment approach; medication as a shortterm solution; high personal and economic costs of medication; and desire for more information and access to natural approaches. Across SL, participants expressed keen interest in integrative approaches and wanted better access to complementary modalities. Participants in marginalized SL described reliance on traditional/folk remedies, including engagement with family and community healers, who they described as more affordable and culturally accessible. Conclusions: Holistic and integrative approaches were preferred over medication as long-term migraine management strategies. However, people in marginalized SL, while disproportionately disabled by migraine, did not feel as comfortable accessing integrative approaches through currently available channels. Engaging with these communities and using a critical lens to explore barriers to access can develop options to make complementary modalities more approachable, while also attending to systemic blind spots that may unintentionally alienate socially marginalized groups.

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Section: Migraine: Incidence Burden and Caim Usementioning

confidence: 99%

Nonpharmacological Self-Management of Migraine Across Social Locations: An Equity-Oriented, Qualitative Analysis

Befus

Hull

Oliveira

et al. 2019

Glob Adv Health Med

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“…2,7 Plausible solutions and strategies to migraine care in underinsured and uninsured adults have been described. 45,46 This analysis showed that race had a significant effect on the rate of consultation. Current consultation rates were highest among Blacks and/or African Americans and lowest among those reporting race categorized as "other."…”

Section: Ta B L E 4 Effect Of Sociodemographic Characteristics On Traversing Barriers To Carementioning

confidence: 89%

“…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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“…The need for equitable Medicaid coverage raises the more general concern about pervasive disparities in the care for headache disorders. Racial and socioeconomic barriers limit access to headache specialty care 86,87 . Low income is associated with higher migraine attack frequency, 88 and some under‐represented groups have a higher prevalence of both poverty and migraine overall (eg, Native Americans) 87 .…”

Section: Future Directionsmentioning

confidence: 99%

What Will it Take to Move the Needle for Headache Disorders? An Advocacy Perspective

Shapiro

2020

Headache

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Discrimination toward people living with migraine and other headache disorders is widespread and socially accepted. Stigma toward these diseases is both a manifestation of these discriminatory attitudes and a sustainer of them. For those living with migraine and headache disorders, stigma limits the full expression of their lives, as well as the likelihood of receiving health care to reduce the burden. In the past decade, public advocacy organizations have emerged in the United States and internationally to counter the consequences of this stigma. These organizations have raised public awareness of these diseases, corrected misconceptions, and empowered millions of people affected by them. The Alliance for Headache Disorders Advocacy has focused on addressing the structural stigma inherent in discriminatory policies of employers, government agencies, and public institutions. While notable progress has been made, there is considerable work left to be done to increase resources and equity for people living with headache disorders.

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Migraine Care Challenges and Strategies in US Uninsured and Underinsured Adults: A Narrative Review, Part 1

Abstract: There are many barriers and challenges that affect people with migraine who are underinsured or uninsured, particularly those of under-represented racial backgrounds and of lower socioeconomic status.

Cited by 22 publications

References 29 publications

Nonpharmacological Self-Management of Migraine Across Social Locations: An Equity-Oriented, Qualitative Analysis

Nonpharmacological Self-Management of Migraine Across Social Locations: An Equity-Oriented, Qualitative Analysis

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

What Will it Take to Move the Needle for Headache Disorders? An Advocacy Perspective

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