OBJECTIVE: To compare healthcare use and drug utilization in patients with migraine and patients without migraine headaches. DESIGN: Retrospective review of Idaho Medicaid claims database for claims filed during 1993 and during 1997. METHODS: Inclusion criteria for the migraine patients were: above the age of 4, with a migraine-diagnosis and one or more prescriptions for migraine medication, enrolled in Medicaid during 1993 and in 1997 (n = 430). The control group (n = 1720) had to have at least one non-migraine-related diagnosis and one or more prescriptions during the study period for inclusion. A control group was matched by age, gender and geographic region. A 4:1 match was performed. Use of health-services and drug-utilization in four identified treatment settings and associated costs were compared between the migraineurs and control group before and after removing migraine-related costs. Differences in costs and utilization of calcium-channel-blockers, anti-depressants, analgesics, anti-migraine preparations, beta-blockers and NSAIDS were analyzed separately. RESULTS: Significant differences (p <0.05) in costs, in all four treatment settings, number of procedures and visits and drug utilization were found in both the years (viz., 1993 and 1997) between the two groups, before and after removing migraine-related costs. After removing migraine-related services and drugs used specifically for migraine, the number of encounters, procedures in ERs, physicians’ office, ‘unknown’ setting, and utilization of analgesics, beta-blockers and NSAIDS remained significantly higher in migraineurs, in both years. Utilization of narcotics were found to be 9 times more among migraneurs in 1993 and 5 times more in 1997. CONCLUSION: Except for hospital outpatient services, migraineurs use healthcare services more than a matched comparison group even after removing migraine-related costs.