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 wide-spread 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 patient clinic and emergency department visits further benefits the current urgent overall societal goal of maintaining social distance to contain the COVID-19 pandemic.