Migraine Care in the Era of COVID‐19: Clinical Pearls and Plea to Insurers

Abstract

Objective.-To outline strategies for the treatment of migraine which do not require in-person visits to clinic or the emergency department, and to describe ways that health insurance companies can remove barriers to quality care for migraine.Background.-COVID-19 is a global pandemic causing widespread infections and death. To control the spread of infection we are called to observe "social distancing" and we have been asked to postpone any procedures which are not essential. Since procedural therapies are a mainstay of headache care, the inability to do procedures could negatively affect our patients with migraine. In this manuscript we review alternative therapies, with particular attention to those which may be contra-indicated in the setting of COVID-19 infection.Design/Results.-The manuscript reviews the use of telemedicine visits and acute, bridge, and preventive therapies for migraine. We focus on evidence-based treatment where possible, but also describe "real world" strategies which may be tried. In each section we call out areas where changes to rules from commercial health insurance companies would facilitate better migraine care.Conclusions.-Our common goal as health care providers is to maximize the health and safety of our patients. Successful management of migraine with avoidance of in-person clinic and emergency department visits further benefits the current urgent societal goal of maintaining social distance to contain the COVID-19 pandemic.

COVID‐19 is a Real Headache!

“…It should also be emphasized that management of preexisting migraine with avoidance of in-person clinic and emergency department visits is important in terms of current societal goal of maintaining social distance during the COVID-19 pandemic. 40 Furthermore, a recent study highlighted that, healthcare workers in Singapore, mandated to wear personal protective equipment (PPE) such as N95 face mask and protective eyewear develop de novo PPEassociated headaches or exacerbation of their preexisting headache disorders. 41 There is also the possibility that COVID-19 as a trigger for headache may induce chronic headache disorders such as new daily persistent headache.…”

Delay in OnabotulinumtoxinA Treatment During the COVID‐19 Pandemic‐Perspectives from a Virus Hotspot

“…These include many of the "bridge" strategies highlighted by the recent Szperka et al publication to help break a severe or continuous pain cycle. 1 Additional treatments that have been offered include short courses of oral corticosteroids, a temporary increase in the dose of existing oral prophylactic treatment, transitioning (perhaps temporarily) to a monoclonal cGRP antibody, and trials of neuromodulation devices.…”

The Value of Headache‐Specific Recommendations During COVID‐19

“…In this issue of Headache, Dr. Szperka and colleagues have created expert guidance for “Migraine Care in the Era of COVID‐19.” 1 This publication is extraordinarily helpful at this time of uncertainty. Providers can utilize this publication to help make effective decisions about treatment approaches for headache patients in the midst of the current COVID pandemic.…”

“…This publication also serves as a demonstration of the value of an established network of committed providers working together for a common goal during “good times,” that becomes invaluable during a crisis. The inspiration for this paper “grew out of conversations during a meeting of the American Headache Society (AHS) Practice Management Committee.” 1 This group was remarkably poised to rapidly create and disseminate such a publication given their longstanding dedication to “Headache Practice Management.” Given their expertise and depth of experience in caring for headache patients, the authors were able to call on their own professional experiences and those of their colleagues to suggest clinical treatment strategies. Further insight was gained from an established online network of female U.S. and Canadian headache specialists, the Facebook group “Migraine Mavens.” The pre‐existing communication networks, the infrastructure support from a national organization, and the representation from providers across the country created an ideal environment ready and able to create such a meaningful document that addresses an important public health issue with rapid turnaround.…”