Transcript: Managing Migraine During COVID-19: Treatment Challenges

Regina Krel, MD: I'm Dr Regina Krel, and I'm the director of the Headache Center at Hackensack University Medical Center at Hackensack New Jersey. I'm also the assistant professor of neurology at Hackensack Meridian School of Medicine.

When the pandemic first hit, the obvious burden on our patients were those patients that came in to get any sort of procedures. So, patients do get Botox injections for chronic migraine. Several neurologists and headache specialists also performed nerve block on patients for occipital neuralgia and cluster headaches and even migraine-type headaches.

And when the pandemic first hit and was at its peak, obviously, that that was no longer available to them because we weren't really coming into the clinic. So, we had to think quickly about how to change gears a little bit. And so, I think the availability of some of those new CGRP monoclonal antibodies really helped because patients that really needed Botox but weren't able to get them were transitioned to one of those agents. So overall, it worked. But it was obviously a limiting factor because insurance obviously played a role, because now I'm waiting to get insurance coverage for a new medication, for example. Some patients may not be candidates for those new agents.

So, I think that was that was kind of what hindered care initially, but I think as time went on, and as things slowly began to reopen, patients were seen in the clinic, more so for, let's say, those procedures. So, patients that really responded well to Botox injections in the past and are now overdue were allowed back in the clinic and they were able to get back on schedule. But initially, that was a very challenging aspect of headache medicine.