2009_migrainequickguide

Assessment and
Physical Exam
Diagnosis
Patient History
■ Presence of pain in the cervical spine.
Neurological Exam
Consider a referral to a
> Several hours to days in duration.
To detect intracranial or systemic disease.
neurologist or headache
specialist if:2
Normal results are consistent with migraine.
Diagnostic Classification
■ Consult headache diary (if available): Cephalagia, 2005; 25: 460-465.
fluctuation, time of day, specific triggers, etc.).
Key Questions for Patients1
your ability to do usual dailyactivities? Some migraine
Make sure your
medications are
appointment with their physician to discuss headache doctor
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 drug-drug interactions.
is aware of all of
Be sure you are aware of
the medications
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.
different doctor.
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
Management4,5
specific details to your doctor. A headache Technology in
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.
Non-Pharmacologic Prevention
and Management
individual is not considerably morelikely than anyone else in the general ■ Avoidance of excessive sensory stimuli: Headache “Red Flags”
Include:
environment can cause or worsenheadaches.
■ Progressively worsening headache.
Pharmacologic Management
Options 4,5
> 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: http://www.aan.com/professionals/practice/pdfs/gl0090.pdf 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
1-800-408-2386.
Call the Precertification unit at
1-800-414-2386.
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
www.aetna.com/formulary.
Consider nonprescription drug alternatives when appropriate, such as aspirin, naproxen lower case italics - Generic medication . sodium, ibuprofen and combination products containing aspirin+acetaminophen+caffeine.
ST -- Step-therapy applies under most plans.
QL -- Quantity limits apply under most plans .
LOWEST TIER
MIDDLE TIER
HIGHEST TIER
FE -- 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.
Antimigraine Agents
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 Other Analgesics
Aetna and the manufacturer of those drugs.
Commercial
California
members:
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.

Source: http://aetnainsurance.net/provider/data/2009_MigraineQG.pdf