About
Thirty years as a headache patient.
Twenty years building advocacy organizations.
I've had headache disorders for most of my adult life. By most measures, I was fortunate — I had access to good clinicians, I lived in a city with specialists, and I had the insurance and the persistence to navigate the system. A lot of people don't.
Before building the Vault, I spent two decades as an executive director — growing the Bicycle Coalition of Greater Philadelphia from a two-person, $140,000 organization to a twenty-person, $1.2 million institution, then leading the League of American Bicyclists nationally. That work was fundamentally about the same thing: identifying where broken systems create inequitable access, and building the infrastructure to fix them.
The access crisis in headache care is an advocacy and infrastructure problem as much as a clinical one. Approximately 800 UCNS-certified headache specialists serving 39 million patients isn't a clinical failure — it's a policy failure with an administrative compounding effect. Prior authorization friction, prescriber knowledge gaps, and documentation errors are modifiable. I know how to work that kind of problem.
Systems can be redesigned. Policies can be re-engineered. The status quo is just the starting point.
Alex Doty
Founder, The Headache Vault · Philadelphia, PA
- 🧠Headache patient — 30+ years
- 🏛️Board member, Alliance for Headache Disorders Advocacy (home of Headache on the Hill)
- 🚲Former Executive Director, Bicycle Coalition of Greater Philadelphia (11 years) and League of American Bicyclists
- 🔬Builder of the largest open headache disorder payer policy dataset
Background
Two decades building advocacy organizations. Now applying the same approach to healthcare access.
The through-line across every role is the same: find where a broken system is producing inequitable outcomes, build the coalition and the infrastructure to change it, and measure success by who gains access they didn't have before.
The Headache Vault is that work applied to healthcare. The access crisis in headache medicine is an advocacy and infrastructure problem. The tools are different — payer policy databases instead of city hall testimony, prior authorization automation instead of trail funding campaigns — but the problem-solving approach is the same.
Bicycle Coalition of Greater Philadelphia
Executive Director · 2004 – 2015
Grew the organization from $140K and 2 staff to $1.2M and 20 staff. Led policy campaigns resulting in $49.5M+ in trail funding, launched citywide bike share equity program, and made traffic safety a mayoral campaign issue.
League of American Bicyclists
Executive Director · 2015 – 2017
National nonprofit advocacy organization, 18,000 members and 200 local advocacy groups. Oversaw the National Bike Summit — a national conference and lobbying day with 500+ participants.
Alliance for Headache Disorders Advocacy
Board Member · Current
Home of Headache on the Hill — the annual Congressional advocacy effort for headache disorder policy reform. The Vault's open policy data is designed to serve this advocacy directly.
The mission
“A patient's ZIP code should not determine their time to treatment.”
The Headache Vault is infrastructure for the headache care community — clinicians, patients, researchers, and policy advocates. It's built to last beyond any one AI platform, any one institutional relationship, and any one funding cycle.
The PA Engine is free for every clinician because access to clinical decision support shouldn't be gated on budget. The patient platform is $25 a year because longitudinal headache tracking shouldn't be a luxury. The policy data is CC BY because open data builds a citation trail that makes advocacy work.
What exists today
Built and live at launch.
Not a roadmap. Not a pitch deck. What you can use today.
Payers in the policy database
Covering all 50 states. Step therapy requirements, formulary tiers, denial codes, and Gold Card law status. Updated quarterly, CC BY licensed.
Clinical guidance cards
Written for primary care clinicians treating headache disorders. CGRP mechanics, step therapy documentation, NDPH, MOH, cluster headache, pediatric cases.
Total policy records
Across 11 structured data files. The largest open, validated headache disorder payer policy dataset in existence.
What the Vault is building
The PA engine is the first checkbox. Here's what it's in service of.
The Access Index
Measuring the gap between 40 million patients and the clinical infrastructure available to treat them — specialist distribution, CGRP prescribing patterns, and payer policy barriers, all 50 states. Live now. CC BY 4.0.
Prior authorization automation
Clinicians complete CGRP and Botox prior authorizations with payer-specific requirements and clinical language generated from patient data. Free for every clinician. No account required. Live now.
Patient functional tracking
A daily diary built around what the disease costs a patient — not a pain scale, but a functional record that feeds directly into clinical documentation, PA evidence, and the research program below. In development.
Clinical outcomes research
A prospective longitudinal dataset to study what actually produces better outcomes — and to develop better methods of measuring headache impact than pain intensity alone. Research infrastructure built. IRB routing in progress.
Provider engagement at scale
Equipping the primary care physicians who have these patients but not yet the tools, the clinical fluency, or the payer knowledge to treat them well. The longer arc.
How we build
The principles behind every decision.
Access over growth
The PA Engine is free for every clinician, no account required, no feature gates. The free tier is a complete reference tool — not a crippled upsell funnel. A clinician treating one headache patient a year deserves the same policy guidance as someone running a headache specialty practice.
Open data builds trust
The payer policy database is CC BY licensed. That means researchers can cite it, advocates can use it in congressional briefings, and clinicians can verify what the engine is working from. The Vault's value is in how it uses the data — not in locking it away.
The patient record belongs to the patient
Your Vault record travels with you across care teams, EHR systems, and AI platforms. Providers you connect with see what you share. Your private notes stay private. Revoking access takes one tap.
Billing is clinical context, not an upsell
CCM reimbursement is surfaced as a clinical tool that helps PCPs build sustainable headache practices — not as a revenue pitch. The economics are real: $42/month per enrolled patient is the mechanism that makes headache-focused primary care financially viable without specialist referral for every patient.
The Vault is infrastructure, not a chatbot
External AI platforms handle conversation, reflection, and emotional support. The Vault holds the structured clinical record — scores, medications, sprints, PA evidence, reports. The patient moves between them with their own data. Neither side tries to be the other.
Clinical grounding
Built in collaboration with the headache care community.
The Vault's clinical content, research architecture, and policy methodology are developed with active input from board-certified headache specialists, policy advocates, and the communities they serve.
Headache specialist collaboration
The Vault's clinical guidance library and research program were developed in active consultation with board-certified headache specialists at major academic headache centers. Clinical accuracy is reviewed against AHS guidelines, ICHD-3 criteria, and current payer policy before any content goes live.
Academic medical centersHeadache on the Hill
The Vault founder serves on the board of the Alliance for Headache Disorders Advocacy — the organization that runs Headache on the Hill, the annual Congressional advocacy effort for headache disorder policy. The open payer policy dataset and access mapping work are designed to serve that advocacy directly.
Federal policy advocacyResearch structured for oversight
The patient outcomes research program is designed with IRB submission in mind from the start — research consent at enrollment, demographic fields that can't be retrofitted, validated instrument collection, and a published data dictionary. IRB routing is in active consultation.
Outcomes researchCMS Medicare Part D source
The provider directory — 7,211 advanced headache prescribers and 39,860 CGRP-prescribing PCPs — is built from CMS Medicare Part D prescribing data. Government source, actual prescription claims, defensible to policymakers and peer reviewers.
Provider access mappingOpen data commitment
The policy and access data are open. That's intentional.
Payer policy data is theoretically public — buried in thousands of plan documents, formulary PDFs, and medical policy bulletins. We collect it, validate it, structure it, and release it under a CC BY license so anyone can use it.
A congressional staffer preparing a brief on step therapy reform should be able to cite this data. A researcher studying geographic access disparities should be able to download it. A clinician in rural Wyoming should be able to verify what their patient's payer actually requires.
Open data builds a citation trail. The Vault becomes the authoritative source not by locking data away — but by being the most reliable, validated, consistently updated version of it.
Payer policy database — CC BY
1,205 payers, 18,284 policy records, all 50 states. Quarterly versioned releases at stable, citable URLs.
Provider access data — CC BY on publication
State-level specialist and PCP density ratios. ZIP-level enrichment coming fall 2026.
Data dictionary — public
All research-relevant fields documented with methodology and intended use. Suitable for IRB submission review.
Policy Pulse — quarterly archive
Versioned quarterly reports documenting what changed each cycle. Permanent, stable URLs.
Get in touch
We want to hear from you.
General and product questions
Questions about the PA Engine, patient platform, pricing, or anything else.
alex@headachevault.comClinical collaboration
Active input from board-certified headache specialists on clinical content, research design, and guideline alignment.
alex@headachevault.comResearch and data use agreements
Researcher access to patient outcomes data (Program A) requires a data use agreement. Policy data (Programs B and C) is CC BY — no contact required.
Research program →Org sponsorship
Payers, employers, and rural health networks interested in sponsoring patient access at $25/patient/year.
alex@headachevault.com