The access crisis in numbers.

An estimated 40 million Americans live with migraine and headache disorders. The clinical infrastructure to treat them — specialist care, CGRP-prescribing primary care, and evidence-based treatment access — falls far short of what is needed.

~40M

Patients with headache disorders

849

UCNS-certified headache specialists

~7,285

Advanced headache prescribers

90.4%

Medicare PCPs who have never prescribed CGRP

What we measured

Provider classification and patient population methodology.

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 medication exposure.

UCNS-certified specialists: Neurologists and physicians holding active United Council for Neurologic Subspecialties certification in headache medicine.

Advanced headache prescribers: Primary care physicians and other non-specialist providers with at least 20 triptan claims to Medicare patients in the measurement year — a working definition of active headache management in primary care.

Patient population

Age- and sex-adjusted Global Burden of Disease prevalence estimates for migraine and headache disorders. Episodic tension-type headache is excluded — this analysis measures the population that requires specialist-level access or proactive treatment intervention.

Prescribing gap definition

An active prescriber is a PCP with ≥20 triptan claims to Medicare patients in the measurement year. A prescribing gap is defined as an active prescriber with zero CGRP medication claims — a clinician treating headache disorders without using the most evidence-supported preventive drug class available.

National Summary

Key findings.

90.4%

of active Medicare triptan prescribers have never written a CGRP prescription

15,624

PCPs in the prescribing gap — treating headache disorders without CGRP

17,284

active triptan-prescribing PCPs in the Medicare dataset

48 / 50

states failing even the 1,200:1 patient-to-prescriber benchmark

Data scope: Medicare patients only. Source: CMS Medicare Part D Prescriber Public Use Files. True national gap likely larger — commercial claims data not publicly available

State Pages

State-level prescribing gap analysis.

Individual state reports are available for all 50 states. Each report includes active prescriber counts, gap percentage, notable metropolitan areas, and a citable citation block. Citation format: Doty A. [State] Medicare Migraine Prescribing Gap. The Headache Vault; 2026.

ALAlabama AKAlaska AZArizona ARArkansas CACalifornia COColorado CTConnecticut DEDelaware DCDistrict of Columbia FLFlorida GAGeorgia HIHawaii IDIdaho ILIllinois INIndiana IAIowa KSKansas KYKentucky LALouisiana MEMaine MDMaryland MAMassachusetts MIMichigan MNMinnesota MSMississippi MOMissouri MTMontana NENebraska NVNevada NHNew Hampshire NJNew Jersey NMNew Mexico NYNew York NCNorth Carolina NDNorth Dakota OHOhio OKOklahoma OROregon PAPennsylvania PRPuerto Rico RIRhode Island SCSouth Carolina SDSouth Dakota TNTennessee TXTexas UTUtah VTVermont VAVirginia WAWashington WVWest Virginia WIWisconsin WYWyoming

States with fewer than 100 active prescribers in the Medicare dataset are excluded from state-level reporting (small-sample suppression).

Advocacy Use

Used on the Hill by Headache on the Hill partners.

The geographic and provider landscape data is used by Headache on the Hill (HOH) partners in congressional briefings to illustrate the specialist shortage and make the case for legislative action on prior authorization reform and access to evidence-based headache care.

All data is CC BY 4.0 and designed to be usable in briefings, grant applications, and publications without requiring data use agreements. The state-level reports provide a citable record for every congressional district.

The Amethyst Standard

The Amethyst Standard is the working benchmark used to assess headache disorder access: a 600–800 patient-to-prescriber ratio, counting UCNS-certified specialists and advanced headache prescribers separately. The benchmark is evidence-informed but not externally validated — it is a working threshold calibrated to the clinical reality of headache disorder care complexity, not a consensus guideline. The finding is robust: at the more lenient 1,200:1 benchmark, 48 of 50 states still fail.

Small-sample exclusion rules

States with fewer than 100 active prescribers in the CMS Medicare Part D dataset are excluded from state-level reporting. This suppression rule applies to DC, Hawaii, and Puerto Rico at current sample sizes. These geographies are not excluded from national aggregates.

Internal tier labels

State pages are internally tiered for media and editorial readiness (Tier 1–3). These labels are not published on state pages — they are operational signals for editorial review prior to Tier 1 state publication. Tier assignment reflects lede and context completeness, not data quality.

Data sources and vintage

Provider data: CMS Medicare Part D Prescriber Public Use Files. Data year: 2022-2023. Scope: Medicare patients only. Only publicly available provider-level prescribing dataset in the US Published: 2026-06-01.

License & Citation

✓ CC BY 4.0

Doty A. Headache Vault Access Index, Component A: Geographic & Provider Landscape.
The Headache Vault; 2026. headachevault.com/research/geographic

For individual state reports, cite as: Doty A. [State] Medicare Migraine Prescribing Gap. The Headache Vault; 2026. with the stable URL for that state page.