Headache & Migraine Disease Working Group

An estimated 39 million men, women and children in the United States, and more than 1 billion people worldwide, experience migraine.  It’s the third most prevalent illness in the world. While some headache disorders disproportionately affect women, others are genetic, afflicting a family one generation after another. Those who have experienced an injury or stroke are also likely to be affected. Meanwhile, migraine and headache disorders have emerged as a common problem for military veterans, particularly those who have been deployed or suffered a traumatic brain injury.

The impact of migraine and headache disorders extends well beyond patients themselves. Families, communities, schools and workplaces all feel these disorders’ effect.  The value of associated health care expenses and lost productivity tops $36 billion annually. And employers experience an estimated $13 billion in losses and 113 million days of missed work. 

Diagnosis and treatment can prove challenging.  “Invisible diseases,” migraine and headache disorders offer no biomarkers.  Patients’ pain is often their primary symptom, and it is a subjective one. Even patients who are properly diagnosed have historically had few treatment options. 

In recent years, innovative medical therapies have emerged to treat and even prevent the onset of migraine attacks. But health plans’ track record of using utilization management and cost-shifting to protect their bottom line can create barriers for patients.  These barriers could take the form of onerous prior authorization, fail first protocols, restrictions about which health care providers can prescribe certain therapies, or cost-sharing schemes that price patients out of access.

Budget-focused policies that take a one-size-fits-all approach to treating migraine and headache disorders can put patients’ health at risk. They can also allow cost-cutting tactics to trump physician insight. For migraine and headache disorders patients to benefit from breakthrough therapies and available treatment options, physicians and patients must continue to drive decisions about clinical care.

To learn more, or to join AfPA’s Headache and Migraine Disease Working Group, please contact Josie Cooper at [email protected].

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