Objective:

To characterize the demographic and clinical features of adults and adolescents seeking care for headache and migraine at a direct-pay tertiary headache clinic.

Background:

A common assumption is that such direct-pay practices attract patients of high socioeconomic status, given the perceived financial barriers to entry.  Timely access to subspecialty care remains a significant challenge in headache medicine, where delays in evaluation and treatment often contribute to poor outcomes, reduced quality of life, and increased healthcare utilization. For patients experiencing acute or chronic worsening of migraine and other headache disorders, the ability to bypass systemic delays may outweigh financial considerations. This raises the question of whether individuals across a broader range of socioeconomic backgrounds perceive sufficient value in the direct-pay model to seek care despite the out-of-pocket cost. 

Design/Methods:

This retrospective cohort study included patients seen between June 2021 and June 2024 at a direct-pay headache practice. Of 103 patients, 99 met inclusion criteria with complete data from initial and three-month follow-up visits. Demographic data, including headache frequency, intensity, and history, were collected from intake questionnaires. Disability and psychological symptoms were assessed using the Migraine Disability Assessment Scale, Patient Health Questionnaire, and Generalized Anxiety Disorder Scale. Residential zip codes were used to estimate median household income and home values based on 2022 census data.

Results:

The 99 patients ranged in age from 14–85 years (mean 38). At baseline, patients reported an average of 21 headache days per month and a mean pain intensity of 6/10 (peak 7/10). Mean MIDAS/PedMIDAS, PHQ-9, and GAD-7 scores were 67.8, 9.1, and 6.8, respectively. The weighted median household income and home value for patients’ zip codes were $94,138 and $302,313.

Conclusions:

Patients presenting to a direct-pay headache clinic demonstrated high disability levels and diverse socioeconomic representation, suggesting that direct-pay models attract individuals across varying backgrounds seeking timely, specialized headache care.