Don’t Let Headaches Be a Pain in the Neck and Your Wallet

Headaches are one of the world’s most common complaints, affecting both children and adults. While this is an infrequent, passing condition for most, there is a minority for which headaches cause significant pain, reduced quality of life and even disability.  One study estimates that “Globally, the percentage of the adult population with an active headache disorder is 47% for headache in general, 10% for migraine, 38% for tension-type headache, and 3% for chronic headache that lasts for more than 15 days per month.”

When the WHO released the update to the Global Burden of Disease Study in 2013, migraine alone was listed as the “6th highest cause worldwide of years lost due to disability (YLD).”  When all headache types were grouped together, they became the 3rd highest.

Headaches lead to higher healthcare cost as well as mounting direct and indirect costs such as work absenteeism and reduced inefficiency.  A study published in 2008, which analyzed paid claims from the Thomson Medstat’s Commercial Claims and Encounters 2004 database, found that migraine patients have “significantly higher average health-care expenditures, ($7007 vs $4436 per person per year; difference of $2571)” compared to their peers.  Additionally, employees who suffered with migraines required 3.8 bed rest days (men) and 5.6 days (women), for a total of 112 million bedridden, missed work days.  Altogether, they estimated that the combined cost, nearly $12 billion, was considered conservative since it did not include over the counter treatment, preventative medications or non-drug interventions.

For patients seeking a drug-free, non-invasive method of healthcare for headaches, chiropractic care is one of the most frequently utilized options.  A North Carolina study found it to also be one of the most cost-effective.  A retrospective closed-claim analysis of the North Carolina State Health Plan (NCSHP) for Teachers and State Employees was conducted utilizing claims from 2000 to 2009.  The claims represented approximately 660,000 covered beneficiaries.  Cost comparisons were made between patients who used:

• MD-only
• DC-only
• MD-DC
• MD-PT
• MD-referral
• DC-referral
• MD-DC-referral
• MD-PT-referral.

Researchers identified all professional and facility claims with a primary diagnosis of headache resulting in over 900,000 claims meeting criteria.  Researchers noted that the number of patients increased over the timespan, from 9,587 in 2000 to 22,780 nine years later, an increase of 138%!

From a financial perspective, the Allowed Yearly Charges (the total of patient responsibility and what the insurance company paid) tripled from $15,187,791 in the year 2000, to $45,446, 882 in 2009.  Looking at the yearly averages, headache related charges increased dramatically from 2000-2005, declined in 2006-2007, then resumed the climb in 2008-2009.

Their analysis revealed a stark discrepancy in the utilization of chiropractic care in relation to its cost-effectiveness.  For example, those who chose chiropractic care represented less than 10% of patients; however, the categories of DC care, alone or in combination with an MD, ranked overall among the top 3 least expensive patterns of headache care.

Risk-adjusted average allowed charges were significantly less for those who chose DC-only care.  Risk scores are utilized by researchers to account for patient-specific factors that could influence results.  Examples are age, comorbidities, and use of prescription drugs.  Utilizing the risk-adjusted data, researchers are able to examine a subgroup of patients who are “in the middle”.  Those with the lowest and highest use and charges are removed, leaving a better look at the “typical” (one whose scores fall in the 40-60% range) patient.

Researchers noted that previous studies have shown chiropractic care to be sensitive to out-of-pocket cost to the patient.  In 2007, the NC legislature reversed a mandate that required copayment equity between primary care and chiropractic care.  The result was that copayments for chiropractic services increased by 20-100% depending on the specific policy.  The study showed that there “were noticeable changes in the total costs for managing the headache population around this time.”  While total charges had been decreasing, when this change took place, the total allowed charges resumed their upward climb.  Researchers speculate that “the change in chiropractic copayments may have shifted the utilization patterns and may partially account for the dramatic increase in costs for the North Carolina NCSHP population”.

Chiropractic care has an excellent track record of providing safe, effective pain relief from multiple types of headaches, including acute, chronic, migraine and cervicogenic headaches.

A primary headache, one where it is not a symptom of an underlying illness, is often associated with muscle tension in the neck.  Your chiropractor can provide treatment that relieves this tension, reducing irritation on the joints of the neck and back, thereby alleviating the pain.

With their whole-person approach to care, chiropractors can also help identify triggers such as foods, environmental stimuli or behaviors that may make a person at higher risk of having headaches, and can provide stretches, activity ergonomics and dietary changes to improve overall health and help reduce headache frequency.  For those in the small percentage of patients whose headache is a warning sign of another cause, a chiropractor can refer to other healthcare providers as needed.

Don’t suffer in pain and miss out on the life you love.  If you are experiencing headaches, see your doctor of chiropractic for cost-effective healthcare.

 

REFERENCES

American Chiropractic Association website. Health & Wellness Information. “Headaches and Chiropractic”. https://www.tnchiro.com/articles/headaches-and-chiropractic/

Hawkins K, Wang S, Rupnow M. Direct cost burden among insured US employees with migraine. Headache. 2008;48(4):553-563. doi:10.1111/j.1526-4610.2007.00990.x

Headache disorders. 8 April 2016. https://www.who.int/news-room/fact-sheets/detail/headache-disorders

Hu XH, Markson LE, Lipton RB, Stewart WF, Berger ML. “Burden of migraine in the United States: disability and economic costs”. Arch Intern Med. 1999;159(8):813-818. doi:10.1001/archinte.159.8.813

Hurwitz EL, Vassilaki M, Li D, et al. “Variations in Patterns of Utilization and Charges for the Care of Headache in North Carolina 2000-2009: A Statewide Claims’ Data Analysis.” J Manipulative Physiol Ther. 2016;39(4):229-239. doi:10.1016/j.jmpt.2016.02.008

Jensen R, Stovner LJ. “Epidemiology and comorbidity of headache”. Lancet Neurol. 2008;7(4):354-361. doi:10.1016/S1474-4422(08)70062-0