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■ Presence of pain in the cervical spine.
Consider a referral to a
> Several hours to days in duration.
To detect intracranial or systemic disease.
neurologist or headache
Normal results are consistent with migraine.
■ Consult headache diary (if available):
, 2005; 25: 460-465.
fluctuation, time of day, specific triggers, etc.).
Key Questions for Patients1
your ability to do usual dailyactivities?
Make sure your
appointment with their physician to discuss
their migraine headaches. Instead, they wait
associated with serious
n Triggers — factors that act as a switch
until they are seeing their doctor for some
is aware of all of
Be sure you are aware of
all the medications your
you are currently
patient is taking.
appointment with your doctor to devote the
time you deserve to your treatment. During
taking, even if they
are prescribed by a
Make a list of information to share
tailored to your specific migraine history.
with your doctor such as:
Keep a headache diary
n Other medications you are taking. Certain
medicines used to treat your headaches on
Use of Diagnostic
specific details to your doctor. A headache
interact with migraine medications and■
identify patter che3
headaches. Because of this, it is extremely
condition. When filling out your diary tion
important to make sur be established.
and include the following information:ache.
treating your headaches is aware of all of
the medications you are currently taking.
individual is not considerably morelikely than anyone else in the general
■ Avoidance of excessive sensory stimuli:
Headache “Red Flags”
environment can cause or worsenheadaches.
■ Progressively worsening headache.
> If nausea/vomiting exists, consider:
1 HIT-6™ 2001 QualityMetric, Inc. Full survey
2 Cady R. and Freitag F. Standards of care for
headache diagnosis and treatment asestablished by the National Headache
3 Frishberg BM, Rosenbert JH, Matchar DB,
Silberstein SD. Evidence-based guidelines in
the primary care setting: neuroimaging inpatients with nonacute Headache. 2000.
■ Goals for successful acute treatment:
available at: http://www.aan.com/professionals/practice
> Treat rapidly and consistently.
Ramadan NM, Silberstein SD, Freitag FG,Gilbert TT, Frishbert BM. Evidence-based
guidelines for migraine headache in theprimary care setting: pharmacological
management for prevention of migraine.
2000. available at:
Pietrzak MP, Silbersten SD, Lipton RB,Ramadan NM. Evidence-based guidelines for
migraine headache in the primary care setting:
attacks. 2000. available at: http://www.aan.com/professionals/practice
6 Kaniecki R, Lucas S. Treatment of primary
headache: preventive treatment of migraine.
In: Standards of care for headache diagnosis
timolol, Topamax. 6
To submit medical exception or precertification
requests for prescription medications:
Fax the Precertification unit at
Call the Precertification unit at
2009 Aetna Preferred Drug List for Commercial plans*
To submit requests online:
• Go to www.aetna.com
• Put your cursor on “Health Care
Professionals” then “Medical”
• Select “Log In” or “Register Now!” to access
our secure provider website via NaviNet®
• Once logged in, select “Plan Central” then
“Aetna Health Plan” and “Precertifications”
Current drug information is available online at
Consider nonprescription drug alternatives when appropriate, such as aspirin, naproxen
lower case italics
- Generic medication .
sodium, ibuprofen and combination products containing aspirin+acetaminophen+caffeine.
-- Step-therapy applies under most plans.
-- Quantity limits apply under most plans .
-- Formulary excluded in closed formulary plans.
P R E S C R I P T I O N M E D I C AT I O N S F O R T R E AT M E N T O F A C U T E AT TA C K S
Nonsteroidal Anti-inflammatory Medications. (NSAIDs)
* Commercial plans = Non-Medicare plans.
ST, QL, FE
All member care and related decisions are the
ST, QL, FE
sole responsibility of the physician, and this
ST, QL, FE
physicians' clinical decisions regarding the
ST, QL, FE
ST, QL, FE
benefits are not limited to the drugs on the
ST, QL, FE
Preferred Drug List. Drugs on the Formulary
Exclusions List may be excluded from coverage
ST, QL, FE
under some pharmacy benefits plans unless a
ST, QL, FE
medical exception is obtained. Many drugs on
the Preferred Drug List are subject tomanufacturer rebate arrangements between
Aetna and the manufacturer of those drugs.
P R E S C R I P T I O N M E D I C AT I O N S F O R P R E V E N T I O N O F A C U T E AT TA C K S .
accordance with state law, California HMOmembers who are receiving coverage for
medications added to the Formulary Exclusions
list, Precertification or Step-Therapy lists will
continue to have those medications covered,
for as long as the treating physician continues
prescribing them, provided that the drug is
appropriately prescribed and is considered safe
and effective for treating the enrollee’smedication condition.
The choices you and your patients make regarding prescription medications affect healthcare costs. Drug prices are a prime contributor to the recent significant increases in the cost
The Preferred Drug List, Formulary Exclusions,
Precertification, Quantity Limit and Step-Therapy Lists are subject to change. Also notethat step-therapy, precertification and quantity
The Savings Can Add Up
limit programs are not applicable in all service
If your patient’s benefits plan has a higher copayment for brand-name medicines that are not
areas. For example, Step-Therapy does not
on the formulary, and if you agree that a generic drug, or a brand-name formulary drug, is
apply to fully insured commercial members inNew Jersey and Indiana.
right for your patient, your patient can begin saving money immediately.
Aetna is the brand name used for products and services provided by one or more of the Aetnagroup of subsidiary companies. The Aetna companies that offer, underwrite or administerbenefits coverage include Aetna Health Inc., Aetna Health of California Inc., Aetna Health of theCarolinas Inc., Aetna Health of Illinois Inc., Aetna Life Insurance Company, Aetna HealthInsurance Company of New York, Aetna Health Insurance Company, Aetna HealthAdministrators, LLC, Cofinity, and Strategic Resource Company. Aetna Pharmacy Managementrefers to an internal business unit of Aetna Health Management, LLC. (Aetna)
This card may not be used after 12/31/09.
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