{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:59:45Z","timestamp":1790711985237,"version":"4.1.0"},"reference-count":76,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to understand the factors limiting access to medications for the preventive treatment of migraine and to improve access to evidence\u2010based preventive care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>For decades, the effective use of medication for the preventive treatment of migraine was limited by slow onset, slow and complex dose titration schedules, modest benefits, drug interactions, frequent side effects, and very low long\u2010term adherence. The calcitonin gene\u2010related peptide (CGRP) targeted preventive medications mitigate some of these limitations and demonstrated substantial therapeutic benefits in a significant proportion of adults with migraine. The American Headache Society considers these medications among the first\u2010line options for migraine prevention, although access to them remains limited. The American Migraine Foundation hosted a single\u2010day, multidisciplinary expert panel discussion to identify barriers to optimal preventive care and developed recommendations to address them.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants identified and prioritized barriers and used a modified nominal group technique to achieve consensus on them. A series of moderated discussions in plenary and breakout sessions was used to create possible solutions. Modified nominal group technique was also employed to achieve consensus on the priorities among these barriers and to achieve whole\u2010group consensus on the recommendations. Ethical issues that inform access were discussed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Participants included eight neurologists and board\u2010certified headache specialists, six representatives of reimbursement decision\u2010makers, six employees of life sciences companies, four patient advocates with lived experience with migraine, and a medical ethicist. Among those who have consulted healthcare professionals and received a diagnosis of migraine, we identified four main barriers to accessing preventive treatment: restrictive prior authorization requirements, the perceived lack of real\u2010world evidence and treatment guidelines, the need for clinician education, and the need for patient education. Consensus recommendations for eliminating barriers centered on using new evidence to evaluate policies that restrict the selection of first\u2010line therapies, initiating\/improving collaboration among stakeholders, sharing of data and best practices, and increased training. Participants agreed to explore novel definitions of the value of preventive treatment and to establish the Migraine Prevention Network to facilitate ongoing cooperation and collective action. However, due to financial limitations, staffing changes, and time constraints, post\u2010meeting discussions led to a shift from establishing a broad Migraine Prevention Network to forming smaller task forces focused on the top\u2010priority barriers (real\u2010world evidence and\n                      <jats:italic>The Patient Playbook<\/jats:italic>\n                      ) identified through collaborative voting among American Headache Society, American Migraine Foundation, and industry stakeholders.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adults with migraine face multiple barriers in accessing novel migraine\u2010specific, CGRP\u2010targeted preventive treatment. Stakeholders in the delivery of care, including clinicians, reimbursement decision\u2010makers, life sciences companies, and patient and clinician advocates, may be able to overcome many of these barriers and improve access by working with and on behalf of patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.15062","type":"journal-article","created":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T05:15:02Z","timestamp":1759554902000},"page":"428-439","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Navigating the patient journey in migraine prevention: An American Migraine Foundation position paper"],"prefix":"10.1111","volume":"66","author":[{"given":"Lawrence C.","family":"Newman","sequence":"first","affiliation":[{"name":"American Migraine Foundation  New York New York USA"},{"name":"NYU Grossman School of Medicine  New York New York USA"},{"name":"Atria Academy of Science and Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Lay","sequence":"additional","affiliation":[{"name":"American Migraine Foundation  New York New York USA"},{"name":"University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2652-2897","authenticated-orcid":false,"given":"Richard B.","family":"Lipton","sequence":"additional","affiliation":[{"name":"Albert Einstein College of Medicine  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Ailani","sequence":"additional","affiliation":[{"name":"MedStar Georgetown University Hospital  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen B.","family":"Digre","sequence":"additional","affiliation":[{"name":"University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur","family":"Caplan","sequence":"additional","affiliation":[{"name":"NYU Grossman School of Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nim","family":"Singh","sequence":"additional","affiliation":[{"name":"American Migraine Foundation  New York New York USA"},{"name":"Atria Academy of Science and Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Phillips","sequence":"additional","affiliation":[{"name":"Migraine Patient Advocate  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Koh","sequence":"additional","affiliation":[{"name":"American Migraine Foundation  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Royce","family":"Warrick","sequence":"additional","affiliation":[{"name":"American Migraine Foundation  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W.","family":"Dodick","sequence":"additional","affiliation":[{"name":"American Migraine Foundation  New York New York USA"},{"name":"Atria Academy of Science and Medicine  New York New York USA"},{"name":"Mayo Clinic  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14153"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1212\/CON.0000000000000199"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182535d20"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000252808.97649.21"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14259"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102416678382"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.13456"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14692"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-025-01365-4"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2010.01778.x"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-019-0743-7"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-021-00982-z"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000208074"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-025-04039-1"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2012.02265.x"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.12774"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14933"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2035908"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-018-0811-9"},{"key":"e_1_2_10_21_1","unstructured":"American Medical Association.2018 AMA Prior Authorization (PA) Physician Survey.2024. Accessed July 28 2025.https:\/\/www.ama\u2010assn.org\/system\/files\/2019\u201002\/prior\u2010auth\u20102018.pdf"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14027"},{"issue":"6","key":"e_1_2_10_23_1","first-page":"505","article-title":"Unintended consequences of prior authorization","volume":"117","author":"Hruza GJ","year":"2020","journal-title":"Mo Med"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.13978"},{"key":"e_1_2_10_25_1","unstructured":"Gold Card Act of 2022.HR 7995.2022. Accessed July 28 2025.https:\/\/www.congress.gov\/bill\/117th\u2010congress\/house\u2010bill\/7995\/all\u2010info"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.120.006564"},{"key":"e_1_2_10_27_1","unstructured":"United Healthcare.How the UnitedHealthcare Gold Card program helps modernize prior authorization.2024. Accessed July 28 2025.https:\/\/www.uhc.com\/news\u2010articles\/newsroom\/gold\u2010card"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsb1609216"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/03331024211053571"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.13653"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.12055"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.318.7182.527"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2008.11.024"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14134"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14116"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-023-04571-z"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1600-0404.2003.00237.x"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1186\/1129-2377-15-56"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-2982.2003.00703.x"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2007.00726.x"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2005.05154.x"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.12623"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.12406"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14425"},{"key":"e_1_2_10_45_1","unstructured":"US Bureau of Labor Statistics.Occupational Outlook Handbook. Physician Assistants.2022. Accessed July 28 2025.https:\/\/www.bls.gov\/ooh\/healthcare\/physician\u2010assistants.htm"},{"key":"e_1_2_10_46_1","unstructured":"US Bureau of Labor Statistics.Occupational Outlook Handbook. Nurse Anesthetists Nurse Midwives and Nurse Practitioners.2022. Accessed July 28 2025.https:\/\/www.bls.gov\/ooh\/healthcare\/nurse\u2010anesthetists\u2010nurse\u2010midwives\u2010and\u2010nurse\u2010practitioners.htm"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1177\/1357633X18782090"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnx187"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-022-05910-6"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.12803"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102415593086"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102419835465"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-1241.2006.01208.x"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102413490343"},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14797"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000200905"},{"key":"e_1_2_10_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2006.11.004"},{"key":"e_1_2_10_58_1","doi-asserted-by":"publisher","DOI":"10.1159\/000505915"},{"key":"e_1_2_10_59_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-59171-4"},{"key":"e_1_2_10_60_1","doi-asserted-by":"publisher","DOI":"10.7249\/RR1567"},{"key":"e_1_2_10_61_1","doi-asserted-by":"publisher","DOI":"10.1310\/hpj5202-155"},{"key":"e_1_2_10_62_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-019-1019-3"},{"key":"e_1_2_10_63_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-015-0498-8"},{"key":"e_1_2_10_64_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14401"},{"key":"e_1_2_10_65_1","unstructured":"American Medical Association.AMA Principles of Medical Ethics.2001. Accessed July 28 2025.https:\/\/code\u2010medical\u2010ethics.ama\u2010assn.org\/principles"},{"key":"e_1_2_10_66_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2007.121343"},{"key":"e_1_2_10_67_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-6296(02)00126-1"},{"key":"e_1_2_10_68_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13023-018-0990-4"},{"key":"e_1_2_10_69_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.25.2.420"},{"key":"e_1_2_10_70_1","doi-asserted-by":"publisher","DOI":"10.1002\/hec.1454"},{"key":"e_1_2_10_71_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2016.01.012"},{"key":"e_1_2_10_72_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.1166"},{"key":"e_1_2_10_73_1","doi-asserted-by":"publisher","DOI":"10.1177\/009286150403800301"},{"key":"e_1_2_10_74_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.3601"},{"key":"e_1_2_10_75_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.15445"},{"key":"e_1_2_10_76_1","unstructured":"US Food and Drug Administration.Expanded Access to Investigational Drugs for Treatment Use\u2014Questions and Answers. Guidance for Industry.2022. Accessed July 28 2025.https:\/\/www.fda.gov\/media\/162793\/download."},{"key":"e_1_2_10_77_1","unstructured":"American Medical Association.Code of Medical Ethics. Chapter\u00a011: Opinions on Financing & Delivery of Health Care.2022. Accessed July 28 2025.https:\/\/www.ama\u2010assn.org\/sites\/ama\u2010assn.org\/files\/corp\/media\u2010browser\/code\u2010of\u2010medical\u2010ethics\u2010chapter\u201011.pdf"}],"container-title":["Headache: The Journal of Head and Face Pain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/head.15062","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/head.15062","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/head.15062","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T08:05:57Z","timestamp":1772957157000},"score":1,"resource":{"primary":{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/10.1111\/head.15062"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,3]]},"references-count":76,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1111\/head.15062"],"URL":"https:\/\/doi.org\/10.1111\/head.15062","archive":["Portico"],"relation":{},"ISSN":["0017-8748","1526-4610"],"issn-type":[{"value":"0017-8748","type":"print"},{"value":"1526-4610","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,3]]},"assertion":[{"value":"2024-10-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}