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A New First Line of Defense for Migraine

Headache experts have aligned on the best way to prevent migraine attacks.

In newly updated guidance, the American Headache Society’s new position statement highlights CGRP inhibitors as the first-line approach to migraine prevention. First approved by the FDA in 2018, the medications can also reduce pain if they’re administered during a migraine attack.

Some CGRP inhibitors are administered by injection and some orally. Both seem to reduce symptoms for both acute and chronic migraine better than triptans and older therapies.

Prescribed by Clinicians, Blocked by Insurers

People with frequent migraine attacks should have access to CGRP inhibitors without having to first try older medications that may not work, the new guidance suggests. That would require a significant change to the status quo.

Health plans frequently require patients to “try and fail” older, less-effective medications before they can access the newer treatment their clinician prescribed. This step therapy process can include subsequent appeals and onerous documentation that extend migraine pain by weeks or months. Migraine is a progressive disease, so any time wasted can lead to more headache days and expensive doctor and emergency room visits.

In a survey of patients who experienced multiple migraines per month, 31% visited an ER for migraine symptoms and 41% developed more serious attacks while waiting for the insurer to approve their prescribed medication. About nine out of 10 patients said their quality of life was negatively impacted by the inability to access the medication they needed.

“[Step therapy] is barbaric,” said one patient in the study, “and contributed significantly to the worsening of my disease.”

Reducing Restrictions to Prioritize Patients

The new American Headache Society guidance, combined with the variety of CGRP inhibitors now available, could help millions of patients return to work, school, and family.

But it’s up to health insurers to put new guidance into practice. That means reducing restrictions that block migraine patients from accessing life-changing care.

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