The Surgical Management Of Migraines And Chronic Headaches: A Cross-sectional Review Of American Insurance Coverage
Kevin Zhu, BS1, Michael Ha, MA Cantab MB BChir1, Salman Chaudry, MD2, Emily Finklestein, BSc3, Nicholas Hricz, BS1, Ledibabari M. Ngaage, MA Cantab MB BChir4, Yvonne Rasko, MD1.
1Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA, 2Department of General Surgery, Anne Arundel Medical Center, Annapolis, MD, USA, 3Ross University School of Medicine, Barbados, Barbados, 4Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital/University of Maryland Medical Center, Baltimore, MD, USA.
PURPOSE: The authors assessed the 101 largest US insurance companies for the surgical and non-surgical management of migraines and headaches. Migraine headache is a debilitating disease that has been traditionally, but often unsuccessfully, treated with analgesics. Surgical management of migraine has recently entered the scientific discourse as a possible treatment. Health insurance is the primary predictor of migraine treatment, but due to the novel nature of these procedures, they may have variable coverage.
METHODS: Companies were selected by state enrollment and market share. Policies were collected via web searches and phone calls. Nine procedures analyzed: nerve decompression surgery, peripheral nerve stimulation, trigger site nerve excision, muscle resection, radiofrequency ablation, botulinum toxin injection, nerve blocks, ablative procedures, and acupuncture.
RESULTS:Of the 101 insurers assessed, significantly fewer held policies for surgical procedures than for nonsurgical procedures (n=52 vs n=78, 52% vs 78%, p<.00001). In addition, there was no significant difference between the number of existing policies for surgical procedures for headache versus migraine (n=52 vs n=50, 52% vs 50%, p=.8881). Headaches were rarely an approved indication for occipital nerve stimulation (n = 2, 4%) or nerve decompression (n = 1, 2%) and always denied for trigger site nerve excision and muscle resection. Migraines were a universally denied indication for all surgical procedure policies.
CONCLUSION:The evidence for the efficacy of migraine and headache procedures is promising for patients who do not respond to first line treatment. As evidence builds, insurers should move to provide alternative treatment options to patients who fail first-line management.
Back to 2022 Posters