Headache Vault Access Index
Measuring the access gap in headache disorder care.
The Index measures access to evidence-based headache disorder care — defined as the gap between the approximately 40 million patients living with headache disorders and the clinical infrastructure available to treat them. Two components: the geographic and provider landscape, and the payer policy landscape. All data is CC BY 4.0 licensed and citable.
The Vault was built by a chronic migraine patient with a background in policy and systems design. The data on this page exists because measuring the access crisis precisely is the first step toward changing it. For the full story, see the About page.
Index Components
Component A
Geographic & Provider Landscape
State-level mapping of headache specialist and CGRP-prescribing PCP density against the patient population. 849 UCNS-certified headache specialists and ~7,285 advanced headache prescribers for an estimated 40 million patients. The Amethyst Standard defines the benchmark. State pages for all 50 states. Includes state-by-state CGRP prescribing gap analysis — 90.4% of active Medicare triptan-prescribing PCPs have never written a CGRP prescription.
View Component A →Component B
Payer Policy Landscape
A versioned, quarterly dataset of what insurers require before authorizing headache disorder treatments across all 50 states — step therapy requirements, formulary tier placements, Gold Card law adoption, and denial patterns. 1,205 payers, 73,828 records. Updated quarterly. CC BY 4.0.
View Component B →Clinical Outcomes Research
A longitudinal dataset the field doesn't have yet.
The Vault is building a prospective longitudinal dataset from enrolled patients — daily functional diary data, validated MIDAS and HIT-6 scores, treatment initiation dates, and PA outcomes — linked to the payer and geographic data above.
The research questions this dataset is designed to answer include: how much do patients systematically underestimate their own disability on standard retrospective instruments compared to prospective daily tracking? What does CGRP treatment response look like in the real-world patient populations excluded from pivotal trials? Does better clinical documentation predict higher PA approval rates? None of these questions are answerable from existing datasets.
The infrastructure is built — research consent at enrollment, validated instrument collection, PA outcome tracking, demographic fields collected prospectively. IRB routing is in active consultation with clinical advisors at major academic headache centers.
For academic collaboration, data use, or research partnership inquiries: alex@headachevault.com
Methodology
How the Index is built.
Patient population: Age- and sex-adjusted Global Burden of Disease estimates for migraine and headache disorders. Episodic tension-type headache is excluded — the Index measures the population requiring specialist-level or proactive treatment access. Full methodology on Component A.
Provider classification: UCNS-certified headache specialists and advanced headache prescribers are counted and reported separately — never combined. Combining them obscures the difference between specialist-level care and primary care with headache exposure. Full criteria on Component A.
Payer policy data: Sourced from primary documents — formulary PDFs, medical policy bulletins, and state legislative records. Each record carries a confidence classification. Gemini Deep Research flags candidates; human review confirms before any record changes. Full methodology on Component B.
Update cadence: Component A updated on publication. Component B updated quarterly — January primary refresh, July mid-year sweep, October ICD-10 update check.
License & Citation
✓ CC BY 4.0Last updated: Q1 2026All Index data is licensed under Creative Commons Attribution 4.0 International (CC BY 4.0). You may use, share, and adapt this data for any purpose — including commercial and research uses — with attribution.
Doty A. Headache Vault Access Index. The Headache Vault; 2026.
headachevault.com/research