171 posters, 10 topics, 5 sessions, 690 authors, 211 institutions

American Association of Plastic Surgeons Meeting 2022

April 9 - 12 | San Diego, California

P120

The Surgical Management Of Migraines And Chronic Headaches: A Cross-sectional Review Of American Insurance Coverage

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Poster Presenter

Michael Ha

Authors

Kevin Zhu, Michael Ha, Salman Chaudry, Emily Finkelstein, Nicholas Hricz, Ledibabari M. Ngaage, Yvonne Rasko

Affiliations

Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, 2 Department of General Surgery, Anne Arundel Medical Center, Annapolis, 3 Ross University School of Medicine, Barbados, West Indies, Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital/University of Maryland Medical Center, Baltimore, Maryland, USA

Part of Topic

General Reconstruction

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 Finkelstein, BSc3; Nicholas Hricz, BS1; Ledibabari M. Ngaage, MA Cantab MB BChir1,4; Yvonne Rasko, MD1

1 Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore

2 Department of General Surgery, Anne Arundel Medical Center, Annapolis

3 Ross University School of Medicine, Barbados, West Indies

4 Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital/University of Maryland Medical Center, Baltimore, Maryland, USA

Introduction

•Migraine headaches are a debilitating disease worldwide, usually, but often unsuccessfully, treated with medications

•Surgical management of migraine headache have been recently researched and discussed as a potential treatment

•However, “Migraine Surgery” is currently a poorly defined term and can refer to many procedures

•Health insurance may predict migraine treatment, but the novelty of these procedures have led to a poorly defined landscape of insurance coverage

Methods

•Cross-sectional analysis of US insurance policies for the surgical and non-surgical management of migraine and headache

•The largest 101 companies were selected based on state enrollment and market share

•Policies collected from websites and phone calls to company representatives

•Surgical procedures analyzed:

•Nerve decompression surgery, peripheral nerve stimulation, trigger site nerve excision, and muscle resection.

•Non-surgical procedures analyzed:

•Radiofrequency ablation, botulinum toxin injection, nerve blocks, ablative procedures, and acupuncture

Discussion

•Of 101 insurers, 52% (n=52) had existing policies on surgical treatments for migraine or headache and 78% (n=78) for nonsurgical treatments

•Significantly fewer existing policies for surgical procedures than for nonsurgical procedures (52% vs 78%, p< 0.0001)

•No significant difference between number of policies for surgical procedures for headache versus migraine (52% vs 50%, p=0.8881)

•Headaches were an approved indication in 4% (n = 2) of occipital nerve stimulation, and 2% (n = 1) of nerve decompression policies

•Migraines were a universally denied indication in all surgical procedure policies

•Insurers denied coverage citing investigational or experimental procedures, lack of efficacy, and methodological flaws in migraine surgery studies

Conclusion

•Currently little recognition by insurers of surgical procedures for migraine or headache as effective therapies.

•As evidence builds, insurers should consider providing access to these alternative treatment options to patients.