Often yes for chronic migraine, but coverage is conditional. Most plans require a documented diagnosis of chronic migraine, meaning fifteen or more headache days a month, plus evidence that other preventive medications have been tried and failed. Prior authorisation is usually needed.
Often yes for chronic migraine, but coverage is conditional. Most plans require a documented diagnosis of chronic migraine, meaning fifteen or more headache days a month, plus evidence that other preventive medications have been tried and failed. Prior authorisation is usually needed.
Three things recur across policies. A documented diagnosis of chronic migraine, which means fifteen or more headache days per month for over three months, with at least eight having migraine features. Evidence of failed trials of other preventive medications, commonly two or more from different classes, at adequate doses for adequate durations. And prior authorisation before the first treatment. Episodic migraine, however severe, is generally not covered because the licensed indication is chronic migraine.
This is the part people underestimate. The fifteen-day threshold has to be documented, not asserted, and a contemporaneous diary is the strongest evidence there is. Reconstructing frequency from memory at an appointment is both less accurate and less persuasive to a payer. Similarly, records of which preventives you tried, at what dose, for how long, and why they stopped are what satisfy the failed-trials requirement. Keeping those records serves your clinical care and your coverage simultaneously.
The practice submits the authorisation request with the clinical documentation; that is not something you have to assemble yourself. Ask three questions: whether onabotulinumtoxinA is on your plan's formulary, what your specialist copay or coinsurance will be, and whether the deductible has been met, since an unmet deductible can mean you owe the full cost even in-network. Coverage is verified before treatment rather than discovered afterwards, and it is re-checked periodically because plans change.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: American Academy of Neurology; MedlinePlus: migraine; MedlinePlus, National Library of Medicine.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.