Why Headaches Are Costly to Patients...and what we are doing about it
By Edmund Messina MD, FAHS
Headache sufferers are in a difficult position, trapped between the personal costs caused by their headaches and what they think might be expensive treatment programs. The following paragraphs discuss these concerns and offer some rational, no-nonsense solutions.
Costs to patients with headaches:
The typical patient with troublesome headaches is losing time from their personal life as well as their work life. Many people lose their jobs because of absenteeism due to headaches. At the very least, they lose income from lost hours and we are all aware of the shaky job market as companies find excuses to "downsize."
Pharmaceutical companies continue to raise their prices, even on generic drugs. Since the advent of the Affordable Care Act, deductibles and copays have skyrocketed, so the average consumer is bearing a large part of their healthcare expenses out-of-pocket before their insurance begins to pay.
Patients with poorly controlled headaches often find themselves in emergency departments. In the current legal climate, ER physicians are likely to order expensive CT scanning on headache patients, exposing the patient to unnecessary radiation as well.
How the Michigan Headache Clinic can help:
The least expensive solution to a headache problem is to make a correct diagnosis in the first place. It is also critical to identify any other factors that make the headaches worse.
These associated issues are called comorbidities and include life stresses, mood disorders, sleep disorders or other medical conditions. Successful headache strategies involve treating the patient as a whole, working in collaboration with the patient's other physicians. This is not a new idea and I have lectured and written on this topic for many years.
W.E. Deming, who pioneered quality management, correctly stated that when we primarily strive for quality, cost savings will follow. This is very true in medicine, especially in our own approach to the practice of Headache Medicine.
There are no gimmicks or shortcuts in treating headache patients; it is simply a question of making the correct diagnoses and then finding logical solutions to these problems. Since there is no such thing as an "average" patient, the approach must be individualized.
Individualized care is only possible when we take detailed medical histories and spend enough time with a patient to truly understand the big picture. Again, there is no shortcut.
The least costly part of headache management is the doctor's visit. Drugs and testing are the main expenses. With a proper medical history and detailed neurological examination, we can avoid going up the many expensive "blind alleys" which patients often experience, which include unnecessary testing and failed medication strategies.
The American Academy of Neurology and the American Headache Society both support the need to avoid unnecessary testing, especially CT scanning, and the need to avoid prescribing narcotics. One of the most common causes of daily headaches, in fact, is the frequent use of pain relieving medications. It is better to prevent headaches than to treat each one as it occurs. Medication overuse headache is a slippery slope.
Prevention of headaches involves a careful assessment of primary and contributing diagnoses, followed by a rational program of lifestyle changes, non-medicinal strategies, relaxation exercises and the careful use of preventative drugs. The plan must be personalized to the individual patient.
We are very aware of the cost of medications and it is fortunate that the majority of our prescription medications are now available as generics... although they may still be expensive. We always keep this in mind when prescribing.
A good headache management plan can drastically reduce the number of times our patients go to an ER or Urgent Care. If our patients do end up in an emergency room with a severe headache, we can advise the ER doctor accordingly, often making scanning unnecessary. We can also legitimize the headache diagnosis so the ER does not think of our patients as narcotic seekers.
Headache problems overlap many other medical problems such as depression, anxiety, hypertension, insomnia, fibromyalgia, neck pain and others. The logical approach is to find strategies that treat as many issues as possible with the least number of medications, and this reduces the chance of drug interactions. We commonly consolidate treatment plans, which makes medicine expenses less of a burden.
We are strong believers that patient education is the key to a successful treatment plan, and we have always used Registered Nurses for patient education in our clinic. My Nurse Practitioners, my PA and I make sure our patients understand their diagnosis and treatment plan before they meet with our RNs who teach them how to use our detailed personalized treatment plan before leaving the clinic. Our telephone nursing support is second to none.
We also believe strongly in coordination of care and we always send progress notes to the other physicians seeing our patients. We welcome return notes or phone calls from our colleagues.
Within the past few months, we have been recognized by pharmacy benefit managers, such as Blue Care Network and Express Scripts, showing that our patients actually spend less on medications, compared to other neurology clinics. This is particularly significant when you consider that we treat patients with the most difficult headache problems from all over Michigan and parts of surrounding states and Canada.
In summary, there are no "magical" solutions to headaches, just logic and attention to detail.
We are always working on new methods for patient evaluation and education, as seen in some of our movies and documentaries and the software we continue to develop. We pioneered the use of computers in outpatient medicine and we patented the artificial intelligence system that we use to take medical histories. Our telemedicine system will lead to making return visits less expensive, and more convenient for our more distant patients.
Please feel free to explore our website in detail.
Edmund Messina, MD, FAHS
Copyright 2018 Edmund Messina M.D., Michigan Headache Clinic