Research Offers New Approach to Help Patients Access Treatment for Migraine.

MedStar Health Research Institute participated in collaborative research led by the American Migraine Foundation to identify systemic barriers to migraine treatment and improve patient access to effective preventive care.

When you’re living with migraine, it’s a daily battle that goes far beyond recurrent nagging headaches. Migraine is a chronic, complex neurological disease that can be disabling, affecting about  over 40 million people in the U.S. However, despite recent advances in treatment, many patients struggle to access care that could significantly improve their quality of life.

The American Migraine Foundation (AMF) has gathered a select group of experts to conduct consensus-building research to identify roadblocks to migraine care and propose ways to clear a path toward better access to prevention.

We’re living in a golden age of treatment. The development of new therapies targeting calcitonin gene-related peptide (CGRP) has revolutionized how we prevent migraine attacks.

But a breakthrough in treatment can only help if a patient can get it. Instead, patients frequently get stuck in a cycle of insurance denials and administrative delays that keep these life-changing medications out of reach. With a fresh research approach, our collaborative team is working to curb these barriers.

A different type of research.

A clinical trial is an essential type of research that helps prove, for example, that a new drug is safe and effective in a controlled environment. But clinical trials often don’t reflect the real-world challenges patients face when they leave my office with a prescription in hand.

To explore these obstacles, the AMF chose a different research approach geared toward building consensus. Our collaborative research team needed to look specifically at the systemic, administrative, and educational factors that can complicate the patient’s journey.

Our goal was to understand the breakdowns in the healthcare system that prevent patients from filling prescriptions that could significantly improve their quality of life. Formally identifying these barriers enables us to design systemic, data-driven solutions. 

Modified nominal group technique: Building consensus.

To explore the complex problem of healthcare access, we used the modified nominal group technique (MNGT). This is a structured method for helping a large group of people with diverse backgrounds and priorities reach a formal agreement on complex issues.

MNGT ensures all voices are heard equally and prevents any one person or industry’s perspective from dominating the conversation. This process was designed to be inclusive and rigorous, following four key steps:

1. Silent generation: Every participant began by identifying their own barriers and solutions before the group discussion.

2. Round-robin sharing: Each idea was then recorded and shared with the whole group for transparency and to assess overlap.

3. Clarification and discussion: In small breakout groups and large plenary sessions, participants refined definitions to ensure we were all using the same language and debated our points.

4. Prioritization and voting: To identify problems and solutions for our final position paper, we used a formal voting process. For a finding to be included, it required at least 75% agreement from the group.

Using this process, we captured stakeholders’ perspectives and integrated their knowledge into consensus-informed recommendations to improve patients’ experience.

Gathering diverse perspectives.

The journey from the doctor’s office to the pharmacy counter involves many different people and perspectives. We intentionally built a panel to represent each corner of the healthcare system. 

The panel included:

• Eight clinical experts: Board-certified headache specialists and neurologists, like me, who treat patients with migraine every day.

• Six insurance decision-makers: Representatives from insurance companies and healthcare payers provided insight into the financial logic behind coverage denials.

• Six industry and ethics experts: Employees from life sciences companies and a medical ethicist provided a balanced view of drug development and fairness in medicine.

• Four patient advocates: Importantly, we included patient advocates with lived experience of migraine. Their presence ensured that we remained focused on the human impact of migraine.

This collaborative method differs from how medical guidelines are usually developed—separately from insurance company policy development. By bringing these four groups together, we created a unique opportunity to find common ground.

The MNGT consensus process enabled us to identify and propose solutions for systemic problems right away. By including patient advocates, we ensured the research was laser-focused on real-world outcomes, such as a patient’s ability to get back to work or be present with their family.

Related: Read “New Headache Research: Atogepant Could be a Safe, Effective Medicine to Prevent Migraines.”

Research into action: The Patient Playbook.

Our research identified four primary barriers that often prevent patients from receiving the care they deserve. These include:

• Insurance restrictions: We identified both prior authorization and step therapy as major hurdles. These policies often force patients to try older, potentially less effective drugs before an insurer will cover newer, evidence-based therapies.

• Data gap: We identified a gap in which insurance companies reported a lack of real-world evidence to justify covering new medications as first-line options for patients.

• Clinician education gap: Many primary care providers and even some specialists are not up to date on the latest American Headache Society guidelines that state that CGRP-targeted treatments can be used as a first-line option.

• Patient empowerment gap: Many patients may lack the tools or information they need to effectively advocate for themselves when an insurance claim is denied.

It’s not enough to just understand the roadblocks. Our research group agreed that the latest medical evidence must be used to challenge insurance policies that restrict access to the most effective treatments. 

Among our exciting outcomes is the strategy for a Patient Playbook. This step-by-step guide will help patients with migraine navigate insurance hurdles, understand their rights, and obtain their medications more efficiently. Specialized task forces on clinician education and data sharing will help us translate these findings into real-world action.

A clearer path toward migraine relief.

The best medicine in the world is useless if a patient can’t access necessary care. Critical research efforts like this AMF initiative enable us to advocate for patients and act for a fairer, more accessible healthcare system.

Collaborative efforts that bring together insurers, advocates, patients, and clinicians can help us move toward our goal: helping more patients access relief from the burden of migraine.