The Cost of Being Diagnosed With (and Getting Treated for) Migraines
Like many people who present at urgent care clutching their foreheads and complaining of inexplicably glittery vision, I have headaches. Really bad ones. But while I suspect I’ve had them since college, I wasn’t officially diagnosed with migraines until last fall, when, after spending a week blogging about the sexist framing of the presidential election and editing an emotionally charged feature about violence against women, I had my first documented “classic migraine,” which is a way-too-elegant descriptor for what feels like my brain shooting lasers into my vision while my head suddenly feels like a rock.
It’s no surprise to me that, according to the Centers for Disease Control and Prevention, headaches are among the top 10 reasons people go to the emergency room. When you have a migraine, it feels like something is very, very wrong with you. And despite how terrifying they can be, migraines are relatively common—about 19 percent of women get them. They’re also mysterious—shocking in pain and presentation—and containing them can be tricky. As with any health issue, the costs of this can add up, even with good insurance. Here are the receipts for treating my achy, temperamental head:
$35 copay: The urgent care visit that started it all. I came home after a very long work day, sat down to watch Crazy Ex-Girlfriend with my roommate, and almost instantly my peripheral vision started to slide away into what looked like a field of lightning. My head felt like it had become a boulder. I tried to follow text on a page but it no longer made sense to me. I didn’t know what was happening. Maybe a panic attack? A stroke? I called my brother, who told me to calm down. I left a voicemail for my mom. I drank tea in the kitchen with my roommate until my vision slowly started to return. Then I took my boulder head to bed.
In the morning, I woke up to a text from my mom, who’s had her own lifelong battle with headaches: “Sounds like a migraine.” At urgent care the next day, I was almost immediately diagnosed with a classic migraine after I gave the kind-eyed nurse practitioner my symptoms and family history. My visual disturbances, the most upsetting part of the previous evening, were part of the migraine’s aura phase, a signal that the monster headache is on its way. On my chart, it says “Migraine with aura and without status migrainosus, not intractable.” The nurse practitioner instructed me to take a large dose of ibuprofen and drink a cup of coffee at the onset of my next migraine. I spent the rest of my evening reading Joan Didion’s uncharacteristically emotive migraine essay “In Bed,” while eating a cheeseburger alone in my favorite neighborhood bar. With prosecco and starch, I toasted the affliction I now shared with my mother and Joan Didion, two of the people I admire most in the world. I was just glad to know what was wrong with me.
$18: Lyft rides between urgent care and my office; $10: Maxalt prescription; $35 copay: Second urgent care visit. The coffee and ibuprofen didn’t work. So, on a day when I absolutely could not afford to go home and be puny in my darkened bedroom, I took a Lyft from work to urgent care for the stronger stuff. (I couldn’t drive—visual disturbances—and the pain was too bad to tolerate on public transit.) I left urgent care with a scrip for Maxalt, which can abort a migraine if you take it as soon as the aura starts and which I now carry in every bag I own whenever I leave the house. Taking Maxalt felt magical. It stopped my migraine within 20 minutes. I felt monstrously tired—almost like being hungover—for the rest of the day, but at least I could see, and my head wasn’t throbbing.
$40: First attempt at acupuncture. Once I started documenting my migraines (I use the euphemistically titled app Migraine Buddy), I found I was getting them at least once a month, and sometimes more when my stress level was particularly high. I’d never had acupuncture before, but studies have shown that it can reduce the frequency of migraines, and at this point I was willing to try anything remotely evidence-based. But after two visits at a community acupuncture clinic—where both times acupuncturists forgot needles in me—I stopped going. I’d gone to the community clinic because it was cheap and open outside of normal business hours, but while I could brush off one forgotten needle as an accident, two seemed like carelessness.
$30 copay: Doctor visit. Like many young people with demanding jobs and busy schedules, I am Not Great at going to the doctor, and hadn’t had a GP in maybe a year after my previous doctor graduated from her residency. But during the Year of Migraines, I finally established care with a nurse practitioner when I found out I could go to a women’s health clinic at a huge teaching hospital for all of my primary care. My new GP is young and funny and has the same first name as me, so we’ll call her Dr. Megan. Dr. Megan refilled my Maxalt prescription and told me that I didn’t have to just accept monthly migraines as part of my life. She gave me a list of herbal supplements to start taking daily, literally wrote me a prescription for massages, and referred me to an in-house acupuncturist, whose existence is one of the benefits of going to a large, well-resourced teaching hospital for your health care. (The drawback is losing your doctor to graduation.)
$30 copays + tip, ongoing: Let’s try massage therapy! One of the things you find out when you start having migraines is that you’re supposed to reduce your stress level. My insurance covers cognitive-behavioral therapy without a copay, and alternative therapies like massage and acupuncture at $30 a visit. Dr. Megan recommended all three, and actually wrote me a prescription for massages. I’m already a big believer in CBT as a way to reduce chronic stress and alleviate physiological symptoms exacerbated or triggered by it, but the jury’s still out on massage. Does it help migraines or is it just pleasant? I don’t follow most of my massage therapist’s advice—sorry, I’m not taking chlorophyll supplements—and sometimes she can be weirdly judgmental in that vaguely disappointed new-agey way—I am pale, therefore I must be anemic, etc.—but I do feel relaxed after getting a massage, and I’m sure that provides some benefit.
$30 copays, ongoing: Second attempt at acupuncture. I was all set to give up on acupuncture entirely until my cousin, who is a neurologist, told me that it had been helpful for some of her patients, echoing Dr. Megan’s advice. I now go to my Dr. Megan’s office for regular acupuncture appointments, which my insurance covers, from a friendly in-house Chinese medicine doctor who jokes about letting me walk out of the treatment room with needles still in my head but would never actually let that happen. Even better, the combination of drugs, acupuncture, and stress reduction seems to be working.
I still get migraines—I probably always will—and I still carry Maxalt with me wherever I go, but almost a year after my first visit to urgent care, I’ve started to get better. I don’t know when my next attack will happen, but the pain-free gaps between my migraines have finally begun to lengthen. As any migraine sufferer can tell you, this is the closest most of us will ever get to being cured.
Megan Burbank is a writer, editor, and migraine sufferer based in Portland, Oregon. She sends out a very sporadic newsletter called The Killjoy Report.
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