title: Impact of insurance status on migraine care in the United States: a population-based study.
abstract: OBJECTIVE
  To determine whether insurance status is associated with differential outpatient treatment of migraine in the United States.
  
  
  METHODS
  We analyzed 11 years of data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (1997-2007), which survey patient visits to doctors' offices, hospital outpatient departments, and emergency departments (EDs) in the United States. We used logistic regression to determine whether insurance status was associated with the prescription of standard migraine therapy, defined as 1) a triptan or dihydroergotamine and 2) a prophylactic agent.
  
  
  RESULTS
  We identified 6,814 individual patient visits for migraine, representing 68.6 million visits nationally. After controlling for age, gender, race/ethnicity, geographic location, and year, migraineurs with no insurance or Medicaid were less likely than the privately insured to receive abortive therapy (odds ratio [OR] for failure to receive medication 2.0 [95% confidence interval (CI) 1.3, 3.0] and 1.6 [95% CI 1.1, 2.3]) and prophylactic therapy (OR 2.0 [95% CI 1.3, 2.9] and 1.5 [95% CI 1.0, 2.1]). Adding site of care to the regression model suggested that one mechanism for this discrepancy was the reliance of the uninsured on EDs for migraine care, a site where standard migraine care is often omitted (OR for failure to receive abortive and prophylactic medication in the ED relative to physicians' offices 4.8 [95% CI 3.6, 6.3] and 8.7 [95% CI 6.4, 11.7]).
  
  
  CONCLUSIONS
  The uninsured, and those with Medicaid, receive substandard therapy for migraine, at least in part because they receive more care in emergency departments and less in physicians' offices.
authors.affiliation: Department of Veterans Affairs, Boise VA Medical Center, University of Washington School of Medicine, Seattle, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilper
authors.forename: Steffie
authors.initials: S
authors.lastname: Woolhandler
authors.forename: David
authors.initials: D
authors.lastname: Himmelstein
authors.forename: Rachel
authors.initials: R
authors.lastname: Nardin
mesh_terms: D000553:Ambulatory Care / Q000191:economics; D004636:Emergency Service, Hospital / Q000191:economics; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D007348:Insurance, Health / Q000191:economics*; D017057:Medically Uninsured; D008881:Migraine Disorders / Q000188:drug therapy* / Q000191:economics*; D015999:Multivariate Analysis; D016017:Odds Ratio; D010044:Outpatient Clinics, Hospital / Q000191:economics; D010045:Outpatients; D010818:Practice Patterns, Physicians' / Q000191:economics; D011787:Quality of Health Care / Q000191:economics*; D012044:Regression Analysis; D014481:United States