What Are Migraine Headaches?
A migraine headache is a neurological disease that can result in debilitating pain, extreme fatigue, nausea, visual disturbances, numbness and tingling, irritability, temporary loss of vision, difficulty speaking, and more. For some, a migraine causes a throbbing headache on one side of the head. Any physical activity, as well as certain smells, sounds, or lights, can worsen the migraine which can last for at least four hours, or for days.
According to the Cleveland Clinic, migraines are the sixth-most disabling disease in the world, and about 12 percent of all Americans experience migraines. Of those, 15-20 percent will have an “aura” along with their migraine. An aura is a group of sensory, motor, and speech symptoms that signal a migraine is close behind. An aura can feel like a stroke or a seizure, can last from 10-60 minutes, and may include one or more of the following:
- Temporary loss of vision
- Tinnitus (ringing in the ears)
- Changes in your speech patterns
- Tingling or numb skin
- Blind spots in your field of vision
- Seeing lights, sparkles, wavy or jagged lines, or bright flashing dots
- Changes in your smell or taste
What Treatments Are Typically Prescribed for Migraines?
Drug therapy is usually the prescribed treatment for migraines. This drug therapy falls into pain-relieving medications and preventative medications. Your doctor will prescribe one or both, depending on your migraine symptoms, including frequency and severity, as well as how disabling your migraines are and whether you have other medical conditions. Medications for the relief of migraine pain include:
- Over-the-counter medications like Advil, Motrin, Ibuprofen, and Tylenol
- Prescription Triptans like Imitrex, Tosymra, and Maxalt which block pain pathways in the brain
- Dihydroergotamine (nasal spray or injection) is most effective for migraines lasting more than 24 hours but can worsen vomiting and nausea in some patients
- Lasmiditan (Reyvow) treats migraines with or without auras. Drug trials have found this drug highly effective in relieving migraine pain but can cause dizziness and sleepiness.
- Ubrelvy and Nurtec are calcitonin gene-related peptide receptor (CGRP) antagonists for acute migraines with or without aura. Emgality is another CGRP. Qulipta, a CGRP, is a daily pill prescribed to prevent migraines. Zavzpret (zavegepant), FDA-approved in March 2023, is the first drug of this kind to treat migraines with or without an aura, or sensory disturbances including flashes of light that may come with a migraine.
- Patients who are unable to take other migraine medications may be prescribed opioid medications, however, these drugs can be highly addictive.
- Anti-nausea drugs like Compro and Reglan can help those whose migraines are accompanied by nausea and vomiting.
- Transcranial Magnetic Stimulation (TMS) Therapy
Preventive drug treatments for migraines include:
- Blood-pressure-lowering medications like Verelan, Lopressor, Inderal, or InnoPran XL
- Certain antidepressants
- Anti-seizure drugs like Topamax and Qudexy XR can help those with less frequent migraines
- Botox injections approximately every 12 weeks can help prevent migraines for some adults
- CGRP monoclonal antibodies like Aimovig, Ajovy, Emgality, or Vyepti are newer drugs given monthly or quarterly by injection.
Non-traditional therapies like acupuncture, biofeedback, cognitive behavioral therapy, meditation, yoga, and certain herbs, vitamins, or minerals may reduce the severity of migraines for some, although the studies are mixed.
Are Migraine Treatments Medically Necessary?
If you were to ask any migraine sufferer whether the treatments are medically necessary, you would certainly receive a resounding “yes.” Those who have never had migraines may not fully understand just how debilitating they are. There can be many care costs that go along with migraines. A letter of medical necessity (LMN) can help confirm your costs are eligible expenses for flexible spending accounts if they are not already covered by insurance.
This letter is a legal document provided by your physician that may make it easier to secure reimbursement from your insurance company for migraine-related treatments including medications, supplements, medical devices, acupuncture, Botox injections, exercise equipment, and fitness programs.
Even with a letter of medical necessity, your insurance company may require “proof” that certain treatments are necessary and may ask your doctor to include all treatments tried before, with an explanation of why those treatments did not work. Submitting an LMN may not necessarily mean your migraine treatment will be approved but can definitely help.
Does Insurance Cover Most Migraine Treatments?
While your insurer may willingly cover less expensive migraine treatments, it may balk at the more expensive treatments. Nurtec can cost more than $1,000 for 8 tablets, Imitrex can run as high as $800 for 9 tablets, and Maxalt is around $500 for 18 tablets. Aimovig and other monoclonal antibodies cost around $600 per injection, while Reyvow costs about $700 for 8 tablets.
As you can see, many of these drugs are expensive, which means your insurer may hesitate at paying for them—or may require you to try other drugs first, then have your doctor submit a statement that the drug did not work for you, before paying for a more expensive migraine drug. Your letter of denial may claim the drug is experimental or that a treatment or drug is not medically necessary.
What Should You Do if Your Insurance Company Won’t Approve Migraine Medication?
Any insurance company—including Anthem Blue Cross, Blue Shield, Health Net, Kaiser, UnitedHealthcare, Aetna, and others—may deny your migraine medication or treatment. Your doctor can re-submit a claim, detailing why the treatment or medication is medically necessary, which could persuade the insurer to pay. If this is not successful, you have several appeal options. Speaking to a knowledgeable migraine treatment insurance denial attorney like Scott Glovsky can be extremely beneficial in getting approval.
How Can the Law Offices of Scott Glovsky Help Following a Migraine Treatment Insurance Denial?
If your insurance company won’t approve migraine medication or you have received a migraine treatment insurance denial, the Law Offices of Scott Glovsky is ready to advocate on your behalf. You will quickly see that there are many things that set our firm apart from others. We are well-respected and have a solid reputation in this area of law.
Attorney Scott Glovsky has experience working on the other side in large corporate law firms, so he knows how insurance companies think and operate. When you choose the Law Offices of Scott Glovsky, you will see our passion and commitment at every turn. We provide personal, caring attention to your issue and have a successful track record for our clients. Contact the Law Offices of Scott Glovsky today.