An estimated 178,397 patients in Virginia are not receiving guideline-appropriate preventive migraine care from their primary care provider
How Virginia compares
Virginia's gap rate of 86.6% is consistent with the national pattern of 90.4%. Of the 292 primary care physicians in Virginia actively treating Medicare patients with migraine, 253 have never written a CGRP prescription. This is not a Virginia-specific failure — it is a national crisis that Virginia is experiencing alongside 47 other states.
What this means for patients
A patient with frequent migraine who sees their primary care physician in Virginia has a 86.6% chance that their doctor has never prescribed a CGRP-targeting therapy. This is not a reflection of physician knowledge or intent — it is the predictable consequence of prior authorization requirements that make CGRP prescribing administratively prohibitive in primary care.
About the data
Based on CMS Medicare Part D prescribing data — the only publicly available provider-level prescribing dataset in the United States. Active prescriber = 20+ triptan claims in the observation period. Medicare patients represent a subset of the total migraine population; the true gap is likely larger. Full methodology →
Getting CGRPs approved in Virginia
Prior authorization burden is the primary structural explanation for this gap. The Headache Vault PA Engine navigates Virginia payer requirements — covering all major commercial insurers and Medicare Advantage plans. Free for all clinicians, no account required.
Run a PA — free →Virginia Medical Society members: this data and tool are free to share with your members. All data on this page is CC BY 4.0.
Citation
Doty A. Migraine Prescribing Gap in Virginia. The Headache Vault; June 2026. Available at: https://headachevault.com/research/prescribing-gap/virginia/ Licensed CC BY 4.0. Data: CMS Medicare Part D Prescriber Public Use Files, 2022-2023.