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