Healthcare Resource Use and Costs Associated with Migraine in a Managed Healthcare Setting

OBJECTIVE: To compare healthcare use and associated costs in patients with migraine and patients without migraine headache. DESIGN: Retrospective review of a managed care organization's medical and pharmacy claims databases for claims filed between January 1, 1989 and June 30, 1990. PATIENTS: Patients between 18 and 64 years old with a 12-month minimum enrollment in the health plan, including enrollment for the prescription drug benefit. Migraine group (n=1336) inclusion required a medical claim with the diagnosis of migraine headache and a pharmacy claim for a medication potentially used for migraine treatment. Comparison group (n=1336) inclusion required at least one medical claim with no diagnosis of migraine; a pharmacy claim was not required. Comparison group patients were matched to migraine group patients by age, gender, enrollment status, and subscriber or dependent enrollment status. OUTCOME MEASURES: Total health services use, diagnosis-specific use of services, diagnostic procedures performed, comorbid conditions, medication use, and associated costs were tallied. RESULTS: Migraineurs generated nearly twice as many medical claims as comparison group patients, and nearly 2.5 times as many pharmacy claims. Number of claims generated and numbers of patients who generated claims within each of 19 diagnostic categories indicated greater comorbidity in the migraine group. Migraineurs used emergency services more than did patients in the comparison group. Total medical and pharmacy claims costs were $3.4 million for the migraine group and $2.1 million for the comparison group. The average amount paid per member-month of enrollment was significantly greater in the migraine group than in the comparison group. Comorbid conditions were responsible for a significant portion of costs in the migraine group. The migraine group incurred $83 537 for diagnostic procedures compared with $13 140 incurred by the comparison group.

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Repeated episodes of focal cerebral ischemia in a patient with mitral valve prolapse and migraine headache

Vojnosanitetski pregled ◽

10.2298/vsp0201081r ◽

2002 ◽

Vol 59 (1) ◽

pp. 81-85

Author(s):

Ranko Raicevic ◽

Aco Jovicic ◽

Dragan Tavciovski ◽

Ljubo Markovic ◽

Natasa Vukotic

Keyword(s):

Mitral Valve ◽

Mitral Valve Prolapse ◽

Migraine Headache ◽

Focal Cerebral Ischemia ◽

Diagnostic Procedures ◽

Ischemic Lesion ◽

Cerebral Parenchyma ◽

Paroxysmal Disorder ◽

Repeated Ischemia ◽

Central Symptom

Migraine is episodic, paroxysmal disorder where the headache represents the central symptom and is followed with different combinations of neurological gastrointestinal and vegetative changes. Not until the diagnostic procedures were developed, ischemic lesions were verified even in the patients with ordinary migraine. This is a report of a patient with migraine headache followed twice by verified episodes of temporary ischemic attacks and verified focal ischemic lesion of cerebral parenchyma. The mitral valve prolapse was also detected. This all imposed the administration of combined prophylactic antimigrainous and anticoagulant therapy as an imperative because of the risk of the development of repeated ischemia of cerebral tissue. This association also confirmed an opinion that migraine is a wider disorder with the dominant dysfunction of limbic system.

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The reasons for an unjustified visit by patients with somatoform disorders to general practitioners

Neurology neuropsychiatry Psychosomatics ◽

10.14412/2074-2711-2018-4-40-45 ◽

2018 ◽

Vol 10 (4) ◽

pp. 40-45

Author(s):

A. V. Pogosov ◽

V. B. Laskov ◽

Yu. V. Bogushevskaya

Keyword(s):

Primary Care Physicians ◽

Information Sources ◽

Psychiatric Care ◽

Comparison Group ◽

Somatoform Disorders ◽

Diagnostic Procedures ◽

Outpatient Setting ◽

Study Group ◽

Behavioral Strategies ◽

Health Care Need

Patients with somatoform disorders (SD) seek specialized psychiatric care late. Although many factors that prevent the timely visits by patients with SD for specialized psychiatric care are known, this problem requires further study.Objective: to analyze the role of information sources and iatrogenic factors in unreasonably selecting a specialist by patients with SD to visit him/her for primary medical advice.Patients and methods. Sixty-six women aged 19 to 40 years with new-onset SD (F 45.0) were examined. Two patient groups were identified: a study group of 41 patients (mean age, 31.5+1.2years) and a comparison group of 25 (mean age, 31.6+0.8years) (p>0.5). Primary care physicians had examined and treated the study group patients long (for 1 to 6 years) before their visit to a psychiatrist. The comparison group patients had been seen by a psychiatrist just in the first year of the disease.Anamnestic, clinical, andpsychopathological methods were used when examining the patients.Results and discussion. For their first visit, the patients with SD had selected a therapist and a neurologist more frequently and a cardiologist and an endocrinologist somewhat less frequently. This selection was also affected by the specialists' high titles, psychiatric consultation-avoiding behavior, and conversion mechanisms. Acquaintances' advice and Internet information as health information sources contribute to the unjustified revisits by these patients to primary medical specialists for a long time. Iatrogenic mechanisms were found to play a role in forming a false concept of a disease and destructive behavioral strategies leading to the chronization and progression of SD. Patients with SD who are long and ineffectively exposed to numerous diagnostic procedures and ineffective treatment in the primary health care need psychiatric counseling and psychotherapeutic support.Conclusion. The diagnosis of SD remains ineffective in an outpatient setting. There is a need for an educational program on SD within the continuing health education system.

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Mid- and Late-Life Migraine Is Associated with an Increased Risk of All-Cause Dementia and Alzheimer’s Disease, but Not Vascular Dementia: A Nationwide Retrospective Cohort Study

Journal of Personalized Medicine ◽

10.3390/jpm11100990 ◽

2021 ◽

Vol 11 (10) ◽

pp. 990

Author(s):

Hyun-Joo Lee ◽

Hyunjae Yu ◽

Son Gil Myeong ◽

Kijoon Park ◽

Dong-Kyu Kim

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Vascular Dementia ◽

Proportional Hazards ◽

Comparison Group ◽

Late Life ◽

Cox Proportional Hazards ◽

Increased Risk ◽

Migraine Group ◽

Prospective Association

We used a nationwide cohort sample of data from 2002 to 2013, representing approximately 1 million patients to investigate the prospective association between migraine and dementia. The migraine group (n = 1472) included patients diagnosed between 2002 and 2004, aged over 55 years; the comparison group was selected using propensity score matching (n = 5888). Cox proportional hazards regression analyses was used to calculate the hazard ratios (HRs). The incidence of dementia was 13.5 per 1000 person-years in the migraine group. Following adjustment for sociodemographic and comorbidities variables, patients with migraine developed dementia more frequently than those in the comparison group (adjusted HR = 1.37, 95% confidence interval [CI], 1.16–1.61). In the subgroup analysis, we found a higher HR of dementia events in male, the presence of comorbidities, and older age (≥65) patients with migraine, compared to those without migraine. Moreover, patients with migraine had a significantly higher incidence of Alzheimer’s disease (adjusted HR = 1.31, 95% CI, 1.08–1.58), but not vascular dementia, than those without migraine. Therefore, our findings suggest that mid- and late-life migraines may be associated with an increased incidence of all-cause dementia and Alzheimer’s disease, but not vascular dementia.

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A 40-Year Follow-Up of School Children with Migraine

Cephalalgia ◽

10.1046/j.1468-2982.1997.1704488.x ◽

1997 ◽

Vol 17 (4) ◽

pp. 488-491 ◽

Cited By ~ 207

Author(s):

B Bille

Keyword(s):

School Children ◽

Migraine Headache ◽

Gradual Increase ◽

Prevalence Study ◽

Recall Bias ◽

Recurrent Headache ◽

Migraine Group ◽

Swedish School

A prevalence study of 9000 Swedish school children conducted in 1955 showed that nearly 4% had migraine. The prevalence of migraine was 1.4% at 7 years of age and 5.3% at 15 years of age. From the age of 11 there was a gradual increase of migraine headache and a predominance among girls. A subgroup of 73 children with pronounced migraine and an average onset of 6 years was followed during a period of 40 years. The results showed that 23% of the children were migraine-free before the age of 25, boys significantly more often than girls. However, around the age of 50, more than half of the migraine group still had migraine attacks. A recall bias was found it that a number of the subjects in their middle-life (41%) could not remember that they had had aura symptoms previously. Of those who had become parents, 52% have in their present or previous families had one child or more who had developed recurrent headache, probably of the migraine-type.

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Temporomandibular Disorders And Migraine Headache: Comorbid Conditions?

The Internet Journal of Dental Science ◽

10.5580/214e ◽

2005 ◽

Vol 2 (1) ◽

Cited By ~ 2

Keyword(s):

Temporomandibular Disorders ◽

Migraine Headache ◽

Comorbid Conditions

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Autism-Current Status and Challenges in Pakistan

Life and Science ◽

10.37185/lns.1.1.208 ◽

2021 ◽

Vol 2 (4) ◽

pp. 1

Author(s):

Rida Fatima Saeed ◽

Sara Mumtaz ◽

Asma Saleem Qazi ◽

Uzma Saeed Awan ◽

Nosheen Akhtar

Keyword(s):

Rural Areas ◽

Cognitive Abilities ◽

Physical Disability ◽

Diagnostic Procedures ◽

Current Status ◽

Mental Disability ◽

Comorbid Conditions ◽

Medical Facilities ◽

Traditional Therapies ◽

Actual Prevalence

Autism is a group of neuro-developmental disabilities. It has an early-onset and can be diagnosed up to 3 yearsof age. It is characterized by disturbances in child's socialization, communication and cognitive abilities, and anunusual repetitive and restricted behavior. The majority of subjects have comorbid conditions. Males are more1 affected than females.1 The prevalence of autism is increasing in the world that could be due to improvement in1 diagnostic procedures and awareness in public and its worldwide prevalence is around 1%.1In Pakistan, there is a lack of widespread awareness and understanding about autism. We do not have exactprevalence data on this disease in Pakistan. However, according to the Autism Society of Pakistan, there are2 probably 350,000 children with this disease in the country.2 But the actual prevalence is believed to be muchhigher. Many cases remain undiagnosed because of unawareness, lack of medical facilities and stigma that is3 attached to mental conditions in Pakistan. In Pakistan, the distribution of disabilities includes mentalretardation (MR), hearing impairment, visual impairment and physical disability. Autism is not considered as adisability in Pakistani society. Moreover, the term mental disability or cognition problem is considered as asocial stigma or disgrace. Therefore, many people do not disclose the condition to avoid stigma. Anotherimportant reason of undiagnosed cases is lack of medical facilities and untrained doctors that categories autism under intellectual disability that is another condition. Many people especially from rural areas opt traditional therapies or go to preachers for healing.

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Triptan persistency among newly initiated users in a pharmacy claims database

Cephalalgia ◽

10.1177/0333102410383058 ◽

2010 ◽

Vol 31 (4) ◽

pp. 488-500 ◽

Cited By ~ 19

Author(s):

Božena J Katić ◽

Srini Rajagopalan ◽

Tony W Ho ◽

Ya-Ting Chen ◽

X Henry Hu

Keyword(s):

Migraine Headache ◽

Migraine Therapy ◽

Claims Database ◽

Pharmacy Claims ◽

Prescription Refill ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

Migraine Medication

Objective Our study was conducted to describe prescription refill patterns among patients newly treated with triptans. Background Although triptans are efficacious in treating migraine headache, the persistency of triptan use among newly initiated users has not been well described. Methods From a US pharmacy claims database, we identified patients receiving new triptan monotherapy prescriptions from 2001 to 2005. Prescription refill information was gathered for two years for each patient. Persistency was defined as sustained refills of the index triptan prescription, regardless of duration between refills. Results Of 40,892 patients receiving a new triptan prescription, 53.8% (N=22031) did not persistently refill their index triptan. Of these, 25.5% discontinued prescription migraine therapy, 7.4% switched to a different triptan, and 67.1% switched to a non-triptan migraine medication at the time of their first refill. Only 46.2% of patients received at least one persistent refill. Conclusions Migraine patients were more likely to discontinue their triptan after their index prescription than at any other time in their prescription refill history. The majority of patients did not persistently refill triptans, but filled prescriptions for non-specific migraine therapies such as opioids and non-steroidal anti-inflammatory drugs. Reasons for triptan discontinuation warrant further investigation.

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Tumor Diagnosis

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100053966 ◽

1982 ◽

Vol 40 ◽

pp. 262-265

Author(s):

Bruce Mackay

Keyword(s):

Electron Microscopy ◽

Transmission Electron Microscopy ◽

Differential Diagnosis ◽

Light Microscopy ◽

Clinical Examination ◽

Ultrastructural Study ◽

Diagnostic Procedures ◽

Specific Diagnosis ◽

Transmission Electron ◽

Microscopic Diagnosis

The broadest application of transmission electron microscopy (EM) in diagnostic medicine is the identification of tumors that cannot be classified by routine light microscopy. EM is useful in the evaluation of approximately 10% of human neoplasms, but the extent of its contribution varies considerably. It may provide a specific diagnosis that can not be reached by other means, but in contrast, the information obtained from ultrastructural study of some 10% of tumors does not significantly add to that available from light microscopy. Most cases fall somewhere between these two extremes: EM may correct a light microscopic diagnosis, or serve to narrow a differential diagnosis by excluding some of the possibilities considered by light microscopy. It is particularly important to correlate the EM findings with data from light microscopy, clinical examination, and other diagnostic procedures.

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