Migraines and Workers’ Comp: A Headache for Payers (Part 2 of 2)
From Pain to Prevention: The Role of Specialty Drugs in Migraine Management
For those who suffer from migraines, the pain is more than just a headache—it’s a full-blown neurological event that can last for hours or even days. Throbbing pain, nausea, vomiting, and extreme sensitivity to light and sound can turn daily life into a struggle. And for some workers, migraines are more than a health issue—they’re a work-related disability.
The Workers' Comp Connection
Believe it or not, migraines can sometimes be linked to workplace factors and may even qualify for workers' compensation. Concussions, blunt trauma, or repetitive neck strain can trigger chronic migraines, often diagnosed as post-concussion syndrome, cervical strain, or occupational overuse syndrome. High-stress work environments, exposure to certain chemicals, and even poor ergonomics can also play a role. Establishing a direct connection between work-related factors and migraines requires strong medical documentation, but with the right care, relief is possible.
A New Era of Migraine Treatment
For years, migraine treatment focused on managing pain and symptoms with NSAIDs, triptans, beta-blockers, antidepressants, and anti-nausea medications. While these treatments worked for some, many migraine patients continued to struggle with frequent, debilitating episodes.
Then came a game-changer: anti-CGRP (calcitonin gene-related peptide) medications. Once thought to be caused primarily by blood vessel dilation, migraines are now understood to involve CGRP, a neuropeptide that plays a key role in transmitting pain signals during an attack. Anti-CGRP medications work by blocking these signals, reducing migraine severity and even preventing attacks before they start.
Specialty Medications Changing How We Manage Migraines
Since the first CGRP monoclonal antibody (mAb) was approved by the FDA in 2018, multiple new treatments have entered the market, offering a targeted, preventative approach to migraine management:
CGRP mAbs for Migraine Prevention
✅ Aimovig® (erenumab-aooe)
How It Works: Blocks the CGRP receptor
Dosing: 70 mg subcutaneous injection once a month; may increase to 140 mg
Best For: Patients looking for long-term migraine prevention
✅ Ajovy® (fremanezumab-vfrm)
How It Works: Binds directly to CGRP
Dosing: 225 mg subcutaneously once a month or 675 mg every 3 months
Best For: Chronic migraine sufferers with a history of medication overuse
✅ Emgality® (galcanezumab-gnlm)
How It Works: Binds directly to CGRP
Dosing:
Migraine prevention: 240 mg loading dose, then 120 mg monthly
Cluster headaches: 300 mg at onset of a cluster, followed by monthly injections
Best For: Patients with both migraines and episodic cluster headaches
✅ Vyepti® (eptinezumab-jjmr)
How It Works: Blocks the CGRP receptor
Dosing: 100 mg IV infusion every 3 months (can increase to 300 mg)
Best For: Patients needing an infusion-based option
What This Means for the Future
These specialty migraine medications are reshaping treatment strategies, offering longer-lasting relief with fewer side effects compared to traditional therapies. As guidelines evolve, CGRP inhibitors are expected to become first-line treatments for many migraine patients.
For workers’ compensation cases, the growing prevalence of these medications means payers and providers must stay ahead of the curve—ensuring that the right protocols for evaluation and coverage of these medications for patients who need them.
With ongoing developments in specialty drugs, the future of migraine treatment is specialty. If you’re managing workers’ comp claims, now is the time to get ahead of the trend and prepare for the increasing role of specialty migraine therapies.
By Estrella Calderon
PharmD Candidate (P4)
For questions, e-mail pharmd@prodigyrx.com
Citations
1. Migraine. National Institute of Neurological Disorders and Stroke. Accessed January 28, 2025. https://www.ninds.nih.gov/health-information/disorders/migraine.
2. Lew C. Migraine medications. National Library of Medicine | National Center for Biotechnology Information. May 1, 2023. Accessed January 28, 2025. https://www.ncbi.nlm.nih.gov/books/NBK553159/.
3. UCLAHealth. Migraine treatments: What are the latest advances? UCLA Health. April 12, 2024. Accessed January 28, 2025. https://www.uclahealth.org/news/publication/migraine-treatments-what-are-latest-advances.
4. Calcitonin gene-related peptide (CGRP) monoclonal antibodies. The Migraine Trust. January 27, 2025. Accessed January 28, 2025. https://migrainetrust.org/live-with-migraine/healthcare/treatments/calcitonin-gene-related-peptide-monoclonal-antibodies/#page-section-2.
5. Muddam MR, Obajeun OA, Abaza A, et al. Efficacy and Safety of Anti-calcitonin Gene-Related Peptide (CGRP) Monoclonal Antibodies in Preventing Migraines: A Systematic Review. Cureus. 2023;15(9):e45560. Published 2023 Sep 19. doi:10.7759/cureus.45560
6. Micromedex Database