Delivering headache care to underserved populations: Results of a neurology clinic embedded in primary care

Background/Objective Underserved populations have worse access to neurologic care and higher risk for worse headache disease burden. We embedded a neurology clinic offering headache services within a primary care clinic treating an underserved population in Boston, Massachusetts, United States. We describe the results of a retrospective review of 1439 outpatient visits during the first three years of operation. Methods Electronic medical record data on demographics, visit types, diagnoses, and medications were extracted and summarized from patient visits completed at the embedded neurology clinic from October 2, 2020, to January 5, 2024. We also reviewed clinic utilization and consult completion rates. Results Over three years, the embedded neurology clinic completed 1439 visits, of which 687 (47.6%) were new patient visits. The consult completion rate was 73.7% (244/331). Patients had a mean age of 52.1 (SD 17.5) years, were 78% women, 68% Hispanic ethnicity and 53% Medicaid/Medicare (public) insurance. The most common diagnosis was a headache or facial pain disorder (46.2%), with migraine diagnoses representing 1/3 of all new patient diagnoses. Of patients diagnosed with migraine, 26.6% were diagnosed with chronic migraine in new patient visits, 48.1% were prescribed an American Academy of Neurology guideline-concordant migraine preventive medication (1/3 of those prescriptions for a CGRP mAB or OnabotulinumtoxinA), and 52.6% were prescribed a guideline-concordant migraine-specific abortive medication (triptan, dihydroergotamine, or gepant). Conclusion Embedding neurologic services within community health centers is a promising model to provide access to headache care for patients from underserved populations. One-third of patients seen received a migraine diagnosis that made them eligible for targeted, disease-specific treatment. Longitudinal studies are needed to evaluate the impact of embedded clinics on migraine-related disability and healthcare utilization.