Why millions of chronic migraine sufferers go untreated

Chronic migraine afflicts more than 4 million Americans, but shockingly less than 5% of them receive appropriate care, according to a new study just published in the journal Headache.

Chronic migraine sufferers experience headaches on more than half of the days and some, every day. These headaches are much more disabling than episodic migraines (those occurring on less than half of the days).

The study established three barriers to an effective treatment of this very common and very disabling condition. The first barrier was being able to see a specialist for a consultation. Those patients who were more likely to get a consultation were older, had more severe migraine symptoms, more disability, and had health insurance.

The second barrier is getting a correct diagnosis. Consulting a specialist rather than a primary care provider, being a female and having more severe migraines increased the odds of a correct diagnosis.

The third barrier was getting proper treatment with preventive medications and Botox injections and acute treatment with triptans and prescription nonsteroidal anti-inflammatory drugs (NSAIDs).

Only 56 (4.5%) out of the 1254 patients evaluated in the study overcame all three barriers and were given appropriate treatment. In a previous study, the same authors found that 26% of patients with episodic migraines traversed all three barriers, which means that only one of of four of more then 30 million Americans with episodic migraines received proper treatment.

The first barrier is possibly the most difficult to eliminate. Despite the fact that the Obamacare provided millions of people with insurance, access to doctors has improved only marginally. A sudden increase in the number of insured was not matched by an increase in the number of doctors. The main bottleneck is not the number of doctors who graduate from medical schools, but the number of residency training positions. Residency training is subsidized by Medicare, which has not increased the number of residencies. We do have a growing number of nurse practitioners and other non-physician healthcare providers who will hopefully make the shortage of doctors less acute. However, this study suggests that migraine sufferers need to see a specialist to receive a correct diagnosis. This does not necessarily mean a physician – we have three nurse practitioners who specialize in treating headaches and who are highly qualified to diagnose and treat various headache disorders.

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