Subspecialty headache clinic visit reduced healthcare utilization in patients with migraine: Single institution retrospective cohort study

OBJECTIVE: This study aimed to evaluate whether care in a subspecialty headache center, compared with a general neurology clinic, was associated with lower 90-day unplanned healthcare utilization (HCU) in patients with migraine and to identify patient-level factors associated with higher unplanned HCU. BACKGROUND: Migraine is a common, disabling condition that frequently prompts emergency department (ED) evaluation and treatment. It ranks among the leading global causes of years lived with disability and imposes a substantial financial burden. People with migraine are most often managed in general neurology clinics rather than in specialty centers. Subspecialty headache centers can offer more advanced and guideline-based care, but their impact on post-visit HCU is not well defined. METHODS: This was a retrospective cohort study of adults with a migraine diagnosis cared for at the University of Pittsburgh Medical Center from 2018 to 2023. Unplanned HCU was defined as any ED visit, urgent care encounter, or hospital admission within 90 days after the index outpatient general neurology or subspecialty headache center visit (first qualifying migraine-coded encounter in the study period). Associations between clinic type and unplanned HCU were evaluated with adjustment for age, sex, race, ethnicity, insurance, Area Deprivation Index, and comorbidities, and, in a subset with available data, Patient-Reported Outcomes Measurement Information System 16-item Profile (PROMIS-16) domains. RESULTS: Of 38,472 patients included, 16,209 (42.1%) were evaluated in the subspecialty headache center. Total 90-day unplanned HCU was 12.6% in the subspecialty headache center vs. 15.4% in general neurology clinics (p < 0.001). Subspecialty headache center evaluation was associated with 15% lower odds of unplanned HCU (adjusted odds ratio [aOR] = 0.85, 95% confidence interval [CI]: 0.79-0.90, p < 0.001). The association remained after accounting for patient characteristics (aOR = 0.87, 95% CI: 0.81-0.92) and PROMIS-16 domains (aOR = 0.67, 95% CI: 0.59-0.76). Higher unplanned HCU was also associated with younger age at diagnosis, Medicaid and Medicare insurance/coverage, non-White races, comorbidities like chronic obstructive pulmonary disease, hypertension, and worse pain interference and physical function scores. CONCLUSION: Evaluation in a subspecialty headache center was associated with approximately 15% lower odds of 90-day unplanned HCU. Subspecialized migraine care may represent a high-value care model.