The Surgical Management of Migraines and Chronic Headaches: A Cross-sectional Review of American Insurance Coverage

Disparities in the Readability and Quality of Online Patient Education Materials for Neurotoxin and Surgical Treatment of Chronic Migraine

The present study aims to evaluate the readability, content quality, and technical quality of online patient educational materials related to surgical intervention and neurotoxin treatment for chronic migraines. An online search using 10 search terms that corresponded to "surgical deactivation" or "neurotoxin treatment" was conducted. For each search term, the first 20 unique results were screened for online patient educational materials related to migraine treatment. Readability, content quality, and technical quality were assessed. Website-specific characteristics, including discussion of insurance coverage, photos, and videos were recorded. Analyses were performed across website types and between broad categories of search terms. Overall, 127 online patient educational materials were included (52% academic/hospital, 29.1% online health reference, 13.4% private practice, and 5.5% other). The average reading grade level was 10.8, which was found to be significantly higher than the AMA/NIH-recommended sixth-grade benchmark (P<0.001). Across website types, academic/hospital websites had a higher reading level than online health reference websites (11.5 vs. 9.7, P<0.001). Online health reference websites had significantly higher content quality scores than both academic/hospital and private practice websites (P<0.001). Notably, online patient educational materials within the "neurotoxin treatment" category were found to have a lower reading grade level (10.1 vs. 11.4) and an increased content quality score compared with those categorized within "surgical deactivation" (P<0.05). Online patient educational materials had a significantly higher reading level than the recommended sixth-grade level. Further efforts must be made to ensure online patient educational materials related to treatments for chronic migraines are accessible.

Surgical Management of Headache Disorders - A Systematic Review of the Literature

PURPOSE OF REVIEW

This review article critically evaluates the latest advances in the surgical treatment of headache disorders.

RECENT FINDINGS

Studies have demonstrated the effectiveness of innovative screening tools, such as doppler ultrasound, pain drawings, magnetic resonance neurography, and nerve blocks to help identify candidates for surgery. Machine learning has emerged as a powerful tool to predict surgical outcomes. In addition, advances in surgical techniques, including minimally invasive incisions, fat injections, and novel strategies to treat injured nerves (neuromas) have demonstrated promising results. Lastly, improved patient-reported outcome measures are evolving to provide a framework for comparison of conservative and invasive treatment outcomes. Despite these developments, challenges persist, particularly related to appropriate patient selection, insurance coverage, delays in diagnosis and surgical treatment, and the absence of standardized measures to assess and compare treatment impact. Collaboration between medical/procedural and surgical specialties is required to overcome these obstacles.

Factors Associated with Patient Adherence to Biofeedback Therapy Referral for Migraine: An Observational Study

Biofeedback has Grade A evidence for the treatment of migraine, yet few studies have examined the factors associated with patients' decisions to pursue biofeedback treatment recommendations. We sought to examine reasons for adherence or non-adherence to referral to biofeedback therapy as treatment for migraine. Patients with migraine who had been referred for biofeedback by a headache specialist/behavioral neurologist were interviewed in person or via Webex. Patients completed an enrollment questionnaire addressing demographics and questions related to their headache histories. At one month, patients were sent a follow-up questionnaire via REDCap and asked if they had pursued the recommendation for biofeedback therapy, their reasons for their decision, and their impressions about biofeedback for those who pursued it. Nearly two-thirds (65%; 33/51) of patients responded at one month. Of these, fewer than half (45%, 15/33) had contacted biofeedback providers, and only 18% (6/33) completed a biofeedback session. Common themes emerged for patients who did not pursue biofeedback, including feeling that they did not have time, concern for financial obstacles (e.g., treatment cost and/or insurance coverage), and having difficulty scheduling an appointment due to limited provider availability. When asked about their preference between type of biofeedback provider (e.g., a physical therapist or psychologist), qualitative responses were mixed; many patients indicated no preference as long as they took insurance and/or were experienced, while others indicated a specific preference for a physical therapist or psychologist due to familiarity, or prior experiences with that kind of provider. Patients with migraine referred for biofeedback therapy face numerous obstacles to pursuing treatment.