The access crisis
7–10 million Americans are clinically appropriate for CGRP therapy. About 575,000 are on it.
For patients with headache disorders who've failed other treatments, the problem isn't the drugs — it's the cascade of administrative, financial, and systemic barriers standing between them and relief. This page documents that cascade with primary sources.
Clinically appropriate patients currently on continuous CGRP or gepant therapy.
The compounding cascade
Each stage loses patients. The barriers compound.
The most modifiable failures aren't clinical — they're administrative. Prior authorization friction, documentation errors, prescriber knowledge gaps. These are solvable problems.
The figures below focus on the CGRP and gepant pipeline for migraine — the best-documented treatment pathway in headache disorders. The access barriers documented here apply broadly across headache disorders, including cluster headache, NDPH, and others.
Of the 7–10 million Americans clinically appropriate for CGRP or gepant therapy — patients who've already failed other treatments — only about 575,000 are on continuous therapy at any given time.
Five stages · documented barriers
Where patients are lost — and why.
For PCPs who prescribe triptans
You're already treating migraine.
Your patients may need one more step.
You know which patients are coming back. The ones who've tried two or three triptans, who still miss work, who cancel plans preemptively. They're clinically eligible for preventive CGRP therapy — and you probably know that.
What stops most PCPs isn't knowledge. It's the busywork.
Prior authorization for CGRP-targeting therapies requires documentation that takes 15 to 45 minutes per submission, with denial rates of 20 to 40 percent on first attempt — and no dedicated PA staff to absorb it. The result is a predictable clinical ceiling: triptans become the end of the line for patients who should be further along.
The Vault removes that ceiling. Enter a patient's insurer and clinical history. Get a complete, payer-specific PA letter — step therapy documented, denial codes anticipated, clinical language aligned to what that payer actually approves. Free, every time, for any patient.
You've already done the hard part. You recognized the diagnosis and started treatment. The Vault does the administrative work that should have never been yours in the first place.
Try it on your next patient →No account required. No subscription. Free.
When you're ready to manage a headache population — tracking PA history, outcomes over time, and coordinating referrals to UCNS-certified headache specialists — the Vault grows with your practice. But the PA tool is free because your patients need it now, not after you've evaluated a platform.
94%
of family practice physicians who prescribe triptans have never written a CGRP prescription.
Source: CMS Medicare Part D, 2023
Sources: AJMC · American Headache Society · American Migraine Foundation · AMA · Association of Migraine Disorders · CMS · Cureus · DLA Piper · FEP Blue · Journal of Headache and Pain · JMCP · Kainth et al. (Neurology & Therapy) · Medscape · NeurologyLive · PAN Foundation · Manufacturer earnings reports (Pfizer, AbbVie, Eli Lilly, Amgen). All figures represent best available estimates from published literature and public data.
Last updated March 2026 · headachevault.com/barriers
The most modifiable barriers sit in the middle of this pipeline.
Prior authorization friction, documentation errors, and prescriber knowledge gaps are administrative problems — not clinical ones. The Vault addresses all three.