NEW: Chronic Migraine Treatment at Rosie Health
Rosie is introducing a new physician-led Botox treatment service for patients with an established chronic migraine diagnosis. This new program provides preventive migraine treatment through a structured referral, coverage and follow-up process. There is no charge for the injection service, and most drug plans provide coverage for the Botox.
To qualify, patients need a referral from a family doctor or nurse practitioner confirming a chronic migraine diagnosis. The attending physician will review each referral before the patient is accepted into the program. Prescription drug coverage is then confirmed before the first treatment appointment is booked.
Who Qualifies for Chronic Migraine Treatment at Rosie?
Rosie's chronic migraine treatment service is for adults with an established chronic migraine diagnosis. Individuals must be referred by a family doctor or nurse practitioner before entering the program. Rosie members can book with one of our nurse practitioners to obtain a referral at no cost.
Chronic migraine disorder is defined by:
1) Headaches on at least 15 days each month for more than three months
AND
2) At least eight of those days must have migraine features
These criterial is based on the International Classification of Headache Disorders.
The referral you submit gives the administering physician information about your migraine history and previous treatments. Relevant medical history, medications, headache frequency and other clinical details may be included as well.
Once the referral is received, the administering physician reviews it to determine whether the program is appropriate for you. This review happens before drug coverage is confirmed and before your first appointment is booked.
If you have a chronic migraine diagnosis, you can request a referral from your family doctor or nurse practitioner. If you're unsure whether your headaches meet the criteria, your healthcare provider can assess your symptoms first. The Rosie treatment service begins once a chronic migraine diagnosis has been established.
The administering physician will not diagnose you with chronic migraine as part of this process. That diagnosis must be established with your general practitioner, or with your Rosie nurse practitioner, before treatment begins.
Do you qualify or have an existing diagnosis?
How Chronic Migraine Treatment at Rosie Works
This new treatment offering follows a clear process, built around your existing diagnosis and referral.
Your family doctor or nurse practitioner sends Rosie a referral confirming your chronic migraine diagnosis. They can use Rosie's referral form or provide the required clinical information through their usual referral process, provided it includes all of the information on our referral form.
Once Rosie receives your referral, the administering physician reviews it and determines whether you're eligible for the program. If you're accepted, Rosie then works with the dispensing pharmacy to confirm your prescription drug coverage. Your Botox is ordered once coverage is approved.
Before your first visit, you'll receive treatment information and a Migraine Disability Assessment, commonly called MIDAS, to complete. MIDAS measures how migraine affects areas such as work, household responsibilities and social activities. Your initial appointment runs about 30 minutes.
Ongoing treatments are typically scheduled every 12 weeks, with follow-up appointments running about 15 minutes. You'll complete MIDAS again before each follow-up, so your care team can track how your symptoms change over time.
If you're a Rosie Health Member and not sure whether your migraines qualify, your nurse practitioner can help you figure out next steps.
Start the process to find out what information you need and what your next step will be.
What Does Chronic Migraine Treatment Cost at Rosie?
Cost depends on your individual prescription drug coverage. For patients who qualify and have private drug coverage for Botox, treatment may come at no out-of-pocket cost.
Chronic migraine treatment involves two separate types of coverage. The physician service is billed through the public health system, at no direct cost to you. Botox itself is not covered by Alberta Health. It's billed through your private prescription drug plan, and may include a copay depending on your coverage.
Rosie confirms your drug plan coverage before your first treatment appointment, so you'll know exactly what to expect.
What Is Chronic Migraine Disorder?
Chronic migraine, sometimes called chronic migraine disorder, is a neurological condition. It's defined by having headaches on 15 or more days a month, for at least three months. At least eight of those days must meet full criteria for a migraine attack.
Migraine symptoms vary between people. They can include throbbing pain, nausea, sensitivity to light or sound and pain that worsens with activity.
The frequency of these symptoms can have a significant effect on everyday life. People living with chronic migraine may find that work, exercise, family responsibilities and social plans become harder to manage.
The MIDAS questionnaire used in Rosie's program helps measure that impact. Tracking headache days also gives patients and their healthcare providers useful information about migraine patterns over time.
Why are Chronic Migraines More Common in Women?
Migraines are considerably more common in women, particularly during the reproductive years. A Canadian clinical review of migraine estimated prevalence at 13.8 per cent among adult women. The same review put the figure at 5.3 per cent among adult men.
Hormonal changes appear to be one factor in this difference. Estrogen interacts with neurological pathways involved in migraine, while changing estrogen levels can influence migraine patterns in some women.
That relationship can become noticeable during reproductive transitions. Migraine patterns may change around menstruation, pregnancy, perimenopause and menopause.
The National Academies review of chronic conditions in women identifies hormonal changes as an important influence on migraines. Estrogen fluctuations are particularly relevant to hormonally sensitive migraines.
For Rosie patients, that connection matters. Migraine patterns may start changing during the same years as other perimenopause symptoms.
How Can Perimenopause Affect Chronic Migraines?
Perimenopause can change migraine patterns for some women as estrogen and other reproductive hormones begin fluctuating more significantly.
Hormone levels can vary considerably throughout the menopause transition. At the same time, women may experience changes in sleep, menstrual cycles, mood and other areas of health.
Research suggests migraines can become more frequent or less predictable during this stage. The same National Academies review notes that migraine may worsen during perimenopause for some women before improving after menopause.
Estrogen appears to play an important role. A rapid decline in estrogen is a recognized trigger for menstrual migraines, while hormone fluctuations become less predictable during perimenopause.
For women who have lived with migraines for years, this can change an established pattern. Headaches may begin occurring at different times or alongside new sleep and menstrual changes.
Hormones are one possible contributor within a broader migraine picture. Sleep, stress, hydration, medications and other individual triggers can also influence when migraines occur.
How Does HRT Fit Into Chronic Migraine Care?
HRT and chronic migraine treatment address different health concerns, although they can intersect during perimenopause.
Hormone therapy may be used to manage appropriate symptoms associated with the menopause transition. Chronic migraine has its own diagnosis, treatment plan and clinical follow-up.
Migraine history still matters when hormone therapy is being considered. The type of migraine, the woman's health history and the route of hormone therapy can all influence treatment decisions.
The 2025 European Society of Endocrinology guideline recommends transdermal estrogen for women with migraines with aura who need hormone therapy. Individual cardiovascular and other health risks also remain part of the assessment.
For Rosie patients, this means migraines can be considered within the broader picture of midlife health. A change in migraine frequency may be worth discussing alongside cycle changes, sleep, mood and other perimenopause symptoms.
HRT may form one part of care when it is clinically appropriate. Chronic migraine treatment remains a separate treatment pathway based on the patient's migraine diagnosis and individual needs.
Why Migraine Tracking Matters During Chronic Migraine Treatment
Tracking migraine frequency helps patients and healthcare providers understand how symptoms change over time.
A headache diary can record the number of headache and migraine days each month. It can also help identify patterns involving menstrual cycles, sleep, stress or other possible triggers.
Rosie also uses the MIDAS questionnaire to measure the effect migraines have on everyday life. Patients complete MIDAS before treatment and again during follow-up care.
Together, headache frequency and disability scores provide useful information about how a patient is doing over time. The administering physician can use this information alongside the clinical assessment to guide ongoing treatment decisions.
For women using HRT, tracking changes can also help identify whether migraine patterns shift alongside hormone treatment. These changes should be discussed with the healthcare provider managing your hormones.
Chronic Migraine Treatment: Frequently Asked Questions
Who Qualifies for Chronic Migraine Treatment at Rosie?
Rosie's program is for adults with an established chronic migraine diagnosis. Patients need a referral from a family doctor or nurse practitioner.
Who Can Access Chronic Migraine Treatment at Rosie?
Any adult with an established chronic migraine diagnosis can access this service. This includes both Rosie members and non-members, of any gender.
Will the Administering Physician Diagnose Me With Chronic Migraine?
No. Diagnosing chronic migraine is not part of this process. Existing Rosie patients can discuss their migraine history with their Rosie Health nurse practitioner. They may be able to help establish a diagnosis.
How Do I Get Started if I Don't Have a Chronic Migraine Diagnosis Yet?
You'll need a chronic migraine diagnosis before entering Rosie's treatment program. Start by discussing your headache frequency and symptoms with your family doctor or nurse practitioner. If your symptoms meet the criteria for chronic migraine, they can provide the referral Rosie needs.
Can a Rosie Nurse Practitioner Submit My Referral?
Yes, for existing Rosie members. If your Rosie nurse practitioner confirms your symptoms meet the threshold for chronic migraine, they can complete your referral directly. The administering physician still reviews every referral before treatment begins, regardless of who submits it.
How Many Headache Days Are Considered Chronic Migraine?
Chronic migraine generally involves headaches on at least 15 days each month for more than three months. At least eight of those days must have migraine features.
Do I Need a Referral for Chronic Migraine Treatment?
Yes. Rosie requires a referral from a family doctor or nurse practitioner before patients can enter the treatment program.
What Happens After Rosie Receives My Referral?
The administering physician reviews your referral first. Once you are accepted, the clinic confirms prescription drug coverage, orders your medication and books your initial appointment.
Does Rosie's Chronic Migraine Program Use Botox?
Yes. Rosie's chronic migraine program uses Botox, a treatment specifically approved for chronic migraine. Botox is administered by a physician as part of your ongoing treatment plan.
Is Chronic Migraine Treatment Covered?
Chronic migraine treatment involves two separate types of coverage. The physician service is billed through Alberta Health, Alberta's public health system, at no cost to you. The cost of Botox itself is not covered by Alberta Health. It will be billed through your private prescription drug plan, and may include a copay depending on your coverage.
How Often Are Chronic Migraine Treatments Scheduled?
Ongoing treatment appointments are generally scheduled every 12 weeks. Rosie also reviews headache patterns and MIDAS scores during follow-up care.
Can Perimenopause Affect Migraines?
Yes. Hormonal fluctuations during perimenopause can influence migraine patterns in some women, particularly those with hormonally sensitive migraine.
Can Women With Migraines Use HRT?
Migraine history is one consideration when hormone therapy is prescribed. Migraine type, hormone delivery method, health history and individual risk factors all help guide treatment decisions.
This article provides general educational information and does not replace individualized medical advice. Speak with a healthcare provider about new, changing or concerning headaches.
Sources
International Headache Society. International Classification of Headache Disorders, Third Edition: Chronic Migraine Criteria. https://pmc.ncbi.nlm.nih.gov/articles/PMC6513576/
Canadian Agency for Drugs and Technologies in Health. Clinical Review: Migraine. https://www.ncbi.nlm.nih.gov/books/NBK596661/?report=printable
National Academies of Sciences, Engineering, and Medicine. Advancing Research on Chronic Conditions in Women. 2024. https://www.ncbi.nlm.nih.gov/books/NBK607719/?report=printable
European Society of Endocrinology. Clinical Practice Guideline for Evaluation and Management of Menopause and the Perimenopause. 2025. https://academic.oup.com/ejendo/article/193/4/G49/8281862
Download this this form if you are a Rosie Member.
Download this referral form and bring it to your primary care provider if you are not a Rosie Member.