Robert E. Shapiro, MD, PhD: Getting Patients Access to Migraine Care


The professor of neurology at the University of Vermont Larner College of Medicine and founding president of the Alliance for Headache Disorders Advocacy discussed the need to get patients with migraine access to medications during the COVID-19 pandemic.

“The good news is that since May 2018, we now have several outpatient medications that are approved for chronic migraine—these are the CGRP medications—that can be given as subcutaneous injections on a 3-month basis by people at home.”

Many patients with migraine and other headache disorders are currently limited to virtual telemedicine visits in the midst of the COVID-19 pandemic, and some have struggled to get access to their regular care, either because of those visit limitations or other challenges. This has led to a need for headache specialists like Robert E. Shapiro, MD, PhD, to attempt to find alternatives.

Shapiro, who is professor of neurology, University of Vermont Larner College of Medicine, and founding president, Alliance for Headache Disorders Advocacy, spoke with NeurologyLive about the ongoing push to transition patients with chronic migraine to the recently approved calcitonin gene-related peptide (CGRP) class of medicines from onabotulinumtoxinA (Botox) therapy. This move has been pushed for due to the ability for patients to administer these therapies on a less frequent, quarterly basis, as well as the fact that they can be administered by the patient themselves, at home.

One of the biggest challenges there has been convincing insurers to allow patients to bypass the normal requirements for these treatments, which often require patients to fail a number of other treatment options before they can get authorization. Shapiro shared his experience with overcoming these administrative barriers in a time of crisis.

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