More than one-third of veterans have been diagnosed with or exhibited symptoms of migraine disease. That’s about twice the national average. This uniquely positions the VA Health Care System to help more veterans get access to innovative treatments.
Rewriting Restrictive VA Guidelines
Updating the VA’s “criteria for use” guidelines for CGRP inhibitors presents one opportunity.
Oral calcitonin gene-related peptide inhibitors are one of the most effective new treatments for migraine. In fact, CGRPs are the first class of drugs specifically developed to prevent – not just treat – migraine, representing a huge opportunity for those who live with the disease.
But the VA guidelines permit only neurologists to prescribe CGRP inhibitors. For veterans, that can mean care delayed, denied or foregone by a range of related barriers:
- Limiting Primary Care Providers: Many veterans’ main point of care is a primary care provider, but these first-line providers are limited in the help they can offer – being able to prescribe only medications that may be less effective.
- Number and Location of Specialists: Some veterans have a neurologist or other headache specialist in their community, but not everyone does. Distance can be a significant barrier, especially for those who live in rural areas. And long waiting periods for an appointment allow the disease to become more chronic and more severe.
The Burden of Migraine Disease Among Veterans
Migraine and headache disorder diagnoses have exploded among the troops in recent decades. Among the generation of soldiers, sailors, aviators, guard members and Marines who fought America’s post-9/11 wars, migraine disease is nothing short of an epidemic.
Veterans with migraine or other headache disorders are also 40% more likely to suffer severe pain than non-veterans. One-fifth of veterans who were concussed on deployment eventually develop daily headache.
Likewise, because of the “warrior effect” – where some veterans perceive their wounds or conditions to be less severe than their fellow vets – headache or migraine attacks may not be taken as seriously by patients, resulting in their not seeking care.
Addressing the Problem
For the sake of veterans’ health, the VA would be wise to implement a multipronged approach to addressing the access issue.
In addition to the VA’s efforts to overcome its workforce shortage, which includes medical specialists, it ought to consider allowing primary care physicians to prescribe CGRPs. They have the medical training and existing patient relationships that could improve health outcomes and quality of life for veterans who are experiencing migraine disease.
Advocates suggest the VA update its policy to allow primary care providers to prescribe CGRPs – allowing them to be part of the solution.