Larry Charleston1, Jeffrey Royce2, Teshamae S Monteith3, Susan W Broner4, Hope L O'Brien5, Salvador L Manrriquez6, Matthew S Robbins7. 1. Department of Neurology, University of Michigan, Ann Arbor, MI, USA. 2. Neuro and Headache Center, SwedishAmerican Hospital, Rockford, IL, USA. 3. Department of Neurology-Headache Division, University of Miami, Miller School of Medicine, Miami, FL, USA. 4. Weill Cornell Medicine Headache Program, Department of Neurology, Weill Cornell Medical College, New York, NY, USA. 5. Division of Neurology, Cincinnati Children's Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA. 6. Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA. 7. Department of Neurology, Albert Einstein College of Medicine, Montefiore Headache Center, Bronx, NY, USA.
Abstract
OBJECTIVE: To review the challenges and potential solutions in treatment options for quality migraine care in adult patients who are under or uninsured. BACKGROUND: The Affordable Care Act has improved access to health care for many; however, those who are underserved continue to face treatment disparities and have inadequate access to appropriate migraine management. METHODS: This manuscript is the second of a 2-part narrative review which was performed after a series of discussions within the Underserved Populations in Headache Medicine Special Interest Section meetings of the American Headache Society. Literature was reviewed for key concepts underpinning conceptual boundaries and a broad overview of the subject matter. Published guidelines, state-specific Medicaid websites, headache quality measurement sets, literature review, and expert opinion were used to tailor suggested treatment options and therapeutic strategies. In this second part of our narrative review, we explored migraine care strategies and considerations for underserved and vulnerable adult populations with migraine. RESULTS: Although common, migraine remains untreated, particularly among those of low socioeconomic status. Low socioeconomic status may play an important role in the disease progression, prescription of hazardous medications such as opioids, outcomes, and quality of life of patients with migraine and other headache disorders. There are some evidence-based and guideline supported treatment options available at low cost that include prescription medications and supplements, though approved devices are costly. Resources available online and simple nonpharmacological strategies may be particularly useful in the underserved migraine population. CONCLUSIONS: We identified and discussed migraine treatment barriers that affect underserved populations in the US and summarized practical, cost-effective strategies to surmount them. However, more research is needed to identify the best cost-effective measures for migraine management in underserved and vulnerable patients who are uninsured or underinsured.
OBJECTIVE: To review the challenges and potential solutions in treatment options for quality migraine care in adult patients who are under or uninsured. BACKGROUND: The Affordable Care Act has improved access to health care for many; however, those who are underserved continue to face treatment disparities and have inadequate access to appropriate migraine management. METHODS: This manuscript is the second of a 2-part narrative review which was performed after a series of discussions within the Underserved Populations in Headache Medicine Special Interest Section meetings of the American Headache Society. Literature was reviewed for key concepts underpinning conceptual boundaries and a broad overview of the subject matter. Published guidelines, state-specific Medicaid websites, headache quality measurement sets, literature review, and expert opinion were used to tailor suggested treatment options and therapeutic strategies. In this second part of our narrative review, we explored migraine care strategies and considerations for underserved and vulnerable adult populations with migraine. RESULTS: Although common, migraine remains untreated, particularly among those of low socioeconomic status. Low socioeconomic status may play an important role in the disease progression, prescription of hazardous medications such as opioids, outcomes, and quality of life of patients with migraine and other headache disorders. There are some evidence-based and guideline supported treatment options available at low cost that include prescription medications and supplements, though approved devices are costly. Resources available online and simple nonpharmacological strategies may be particularly useful in the underserved migraine population. CONCLUSIONS: We identified and discussed migraine treatment barriers that affect underserved populations in the US and summarized practical, cost-effective strategies to surmount them. However, more research is needed to identify the best cost-effective measures for migraine management in underserved and vulnerable patients who are uninsured or underinsured.
Authors: Juliana H VanderPluym; Larry Charleston; Michael E Stitzer; Charles C Flippen; Cynthia E Armand; Jessica Kiarashi Journal: Curr Pain Headache Rep Date: 2022-03-26
Authors: Jessica Kiarashi; Juliana VanderPluym; Christina L Szperka; Scott Turner; Mia T Minen; Susan Broner; Alexandra C Ross; Amanda E Wagstaff; Marissa Anto; Maya Marzouk; Teshamae S Monteith; Noah Rosen; Salvador L Manrriquez; Elizabeth Seng; Alan Finkel; Larry Charleston Journal: Neurology Date: 2021-06-09 Impact factor: 11.800