{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T10:46:55Z","timestamp":1792061215794,"version":"4.4.0"},"reference-count":32,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to evaluate whether care in a subspecialty headache center, compared with a general neurology clinic, was associated with lower 90\u2010day unplanned healthcare utilization (HCU) in patients with migraine and to identify patient\u2010level factors associated with higher unplanned HCU.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u2010based care, but their impact on post\u2010visit HCU is not well defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2009days after the index outpatient general neurology or subspecialty headache center visit (first qualifying migraine\u2010coded 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\u2010Reported Outcomes Measurement Information System 16\u2010item Profile (PROMIS\u201016) domains.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 38,472 patients included, 16,209 (42.1%) were evaluated in the subspecialty headache center. Total 90\u2010day unplanned HCU was 12.6% in the subspecialty headache center vs. 15.4% in general neurology clinics (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Subspecialty headache center evaluation was associated with 15% lower odds of unplanned HCU (adjusted odds ratio [aOR]\u2009=\u20090.85, 95% confidence interval [CI]: 0.79\u20130.90,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The association remained after accounting for patient characteristics (aOR\u2009=\u20090.87, 95% CI: 0.81\u20130.92) and PROMIS\u201016 domains (aOR\u2009=\u20090.67, 95% CI: 0.59\u20130.76). Higher unplanned HCU was also associated with younger age at diagnosis, Medicaid and Medicare insurance\/coverage, non\u2010White races, comorbidities like chronic obstructive pulmonary disease, hypertension, and worse pain interference and physical function scores.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Evaluation in a subspecialty headache center was associated with approximately 15% lower odds of 90\u2010day unplanned HCU. Subspecialized migraine care may represent a high\u2010value care model.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.70220","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T10:08:34Z","timestamp":1792058914000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Subspecialty headache clinic visit reduced healthcare utilization in patients with migraine: Single institution retrospective cohort study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1658-8502","authenticated-orcid":false,"given":"Megan","family":"Trenz","sequence":"first","affiliation":[{"name":"Department of Neurology University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3230-9962","authenticated-orcid":false,"given":"Raja Narendra Divakar","family":"Addanki","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Raad","sequence":"additional","affiliation":[{"name":"Human Engineering Research Laboratories Department of Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Kaniecki","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janel","family":"Hanmer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manisha","family":"Jhamb","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wesley T.","family":"Kerr","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parthasarathy D.","family":"Thirumala","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pittsburgh  Pittsburgh Pennsylvania USA"},{"name":"Department of Neurosurgery University of Pittsburgh  Pittsburgh Pennsylvania 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