Letter from the Editor
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In a perfect world every new treatment for migraine would become available immediately to patients, without the need for prior authorization (PA) from an insurer and and little or no out-of-pocket cost. Patients would present to their providers for evaluation of migraine, and those whose headache burden required it would leave with a treatment strategy likely to include one of the new “designer drugs“ indicated for migraine prevention. Treatment could commence that same day.
Shoreline sunrise
Encinitas, California
{courtesy of Jack Schim, MD}
In the world we currently inhabit, however, things are not so simple. Inevitably, for a patient to successfully fill a prescription for any of the new designer drugs for migraine prevention or acute migraine treatment will require a PA, and to obtain a PA may require the patient to first try and fail multiple other older and less expensive alternatives.
Once that hurdle has been cleared, there remains the question of how to choose for, say, suppression of chronic migraine which of the six evidence-based options now available … with a seventh likely soon to join the crowd.
What are the “old“ alternatives that patients must first try, and how do they compare with the new kids on the block? How to choose amongst the newbies? These are important questions we will begin to address in this issue.
