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Sumanjit Kaur, Amy Gonzales from Doctor Unite Commented on a Post
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Episodic and Chronic Migraine Treatment during the COVID-19 Pandemic

COVID-19 has made it necessary for clinicians to adapt how they diagnose, treat, and manage patients with chronic diseases, including migraine. With lockdowns and patients concerns about leaving their homes, telemedicine and the availability of efficacious self-administered therapies, such as subcutaneous prophylactic CGRPs, have facilitated the continued care of migraineurs.

Initiation of prophylactic CGRPs is typically prescribed for migraineurs with 4+ migraine days per month who have failed 2+ oral therapies However, since the COVID-19 pandemic, migraine treatment decisions have likely changed due to Botox injection cancellations, potential SARS-CoV-2 infections, increased anxiety or headache triggers, and putative links between the use of certain drugs, such as angiotensin‐converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), and increased COVID-19 infection risk1. (I would delete this portion because it relates to hospitalized COVID-19 patients)

How has the COVID-19 pandemic impacted your prescribing decisions regarding the initiation of prophylactic CGRP therapy in episodic and chronic migraine patients? What are the factors that contribute to treatment selection during the pandemic?

1 https://www.acc.org/latest-in-cardiology/articles/2020/03/17/08/59/hfsa-acc-aha-statement-addresses-concerns-re-using-raas-antagonists-in-covid-19
 

  • 1 week 1 day
    I am prescribing CGRP inhibitors , pandemic has not effected my decision, preauthorisation process is the one that takes time..
  • from Doctor Unite 1 week 1 day
    Some of the factors that contribute to treatment selection would be the patients history of using previous medications for migraines, effectiveness of switching to a new medication, and mode of administration to comply with social distancing.
  • from Doctor Unite 1 week 1 day
    While it is a bit uncomfortable to prescribe such medications without the typical "hands-on" of an office visit, the criteria for therapy initiation remain the same. After a lengthy discussion with the patient involving risks, side-effects, precautions, dasnger signs, etc., I will proceed with therapy.
  • from PA Unite 1 week 1 day
    The same increase in prescriptions number applies for acute treatment with anti-CGRP meds as well as chronic tx.
  • from PA Unite 1 week 1 day
    Anti-CGRP meds are great for most of the patients with chronic migraine, so the prescriptions number has increased during the covid19 pandemic, along with more migraine due to increased stress, job uncertainty, and headache as one of the first signs of covid infection.
  • from Doctor Unite 1 week 1 day
    Since the COVID-19 pandemic, I have utilized telemedicine more. I have prescribed more prophylactic CGRPs especially during this time of increased anxiety.
  • from Doctor Unite 1 week 1 day
    I am seen the migraine patients in the office, prescribing the prophylactic CGRP meds, triptans, and some injectables for the chronic migraine prevention
  • from Doctor Unite 1 week 1 day
    I arose patients in the office and have prescribed this class with very effective results
  • 1 month
    I have done a lot more telehealth since the pandemic started and thinking earlier about cGRP inhibitors since botox and other procedures in the office are more difficult to do.
  • from Doctor Unite 1 month 1 week
    More telemedicine but I’m still prescribing these medications
  • from Doctor Unite 1 month 1 week
    The epidemic has not affected my ability to prescribe CGRP inhibitors. When deemed necessary, there is a fairly involved preapproval process required to get these meds covered by insurance which is the major time limiting factor in prescribing the class. The process is generally done on the phone and online and has not changed with COVID-19.