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Uninsured get poor care for migraine: Harvard study

U.S. health system causes headaches in more ways than one, researchers say

EMBARGOED until     
Monday, April 12, 2010

Contacts:
Rachel Nardin, M.D.
Andrew P. Wilper, M.D., M.P.H
Steffie Woolhandler, M.D., M.P.H.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

Migraines, often characterized by excruciating headache and nausea, are much worse for the uninsured, a new Harvard Medical School study shows.

Researchers say migraine sufferers who lack private health insurance get poor care for their condition. They are about twice as likely to get inadequate treatment for their headaches as their privately insured counterparts. People with Medicaid also get substandard care.

Because migraine is common in the United States, affecting about 18 percent of women and 6 percent of men, and because so many Americans lack health insurance, a startling 5.5 million people are at risk of getting substandard care for their often painful and disabling headaches, the researchers say.

The study, titled "The impact of insurance status on migraine care in the United States: a population based study," was published today [Tuesday, April 13] in Neurology, the world's leading clinical neurology journal.

Study senior author Dr. Rachel Nardin, assistant professor of neurology at Harvard and chief of neurology at the Cambridge Health Alliance in Massachusetts, said: "The tragedy is that we know how to treat this disabling condition. But because they are uninsured or inadequately insured, millions of Americans suffer needlessly.

"Unfortunately," she said, "the new health law doesn't fully address this problem. At least 23 million people will remain uninsured nine years out.

"Optimizing migraine care requires improvement in our health care systems as well as educating physicians to prescribe the best available drug and behavioral treatments."

The researchers analyzed data from two federal surveys, the National Hospital Ambulatory Medical Care Survey and the National Ambulatory Medical Care Survey, which together provide a nationally representative sample of all U.S. visits to doctors' offices, hospital clinics and emergency rooms. They analyzed the 6,814 visits for migraine between 1997 and 2007, representing 68.6 million visits nationwide.

Neurologists recommend two types of drugs when a moderate-to-severe migraine strikes: "triptans" (such as sumatriptan) or dihydroergotamine (DHE). For the majority of migraine sufferers whose headaches are frequent or severe, neurologists also recommend a daily dose of one of several preventive medications.

The researchers used these recommendations from the American Academy of Neurology to define standard migraine treatment and found that the uninsured were nearly twice as likely as the privately insured to receive substandard treatment.

Medicaid enrollees were 50 percent more likely to receive substandard treatment, suggesting that "access to some forms of insurance is not the same as access to adequate care," the researchers wrote.

Care in doctors' offices was substantially better than in emergency departments. The fact that the uninsured are less likely to get care in doctors' offices explained some, though not all, of their substandard care.

Most people with migraine are impaired by their headaches and the accompanying nausea, and lose an average of four to six days of work annually.

Dr. Steffie Woolhandler, professor of medicine at Harvard and study co-author, said: "Lack of insurance clearly takes a heavy toll on our patients and the economy. Regrettably, the health bill just signed into law will leave tens of millions of Americans uninsured or poorly insured and thus unable to get the care they need."

Dr. Andrew Wilper, lead author of the study, said: "We showed that the uninsured have a higher risk of death when compared to those with insurance. Lack of insurance also puts patients with migraine at risk for needless suffering due to lack of access to standard medical therapy."

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"The Impact of Insurance Status on Migraine Care in the United States: A Population Based Study," Andrew P. Wilper, M.D., M.P.H., Steffie Woolhandler, M.D., M.P.H., David U. Himmelstein, M.D. and Rachel Nardin, M.D. Neurology, April 13, 2010.

A limited number of patient stories are available upon request from Mark Almberg, (312) 782-6006, mark@pnhp.org.

Physicians for a National Health Program (www.pnhp.org) is an organization of 17,000 doctors who support single-payer national health insurance. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.