Insurers count your headache days and quietly ignore the postdrome.

Fourteen days on the form, twenty-eight in your body

The prior-authorization form has one box that decides everything: migraine days per month. You write fourteen. There's no box for the day after each of those fourteen, the one where the light over the sink still stings and a two-line text takes four tries to answer. No box for the neck that won't turn, the sentence that dissolves halfway through. Your neurologist's letter will list your failed medications, your headache frequency, your ER visits. It will almost certainly stop where the pain stops. And so will the number your insurer uses to decide whether you're sick enough for a CGRP drug.

The uncounted days

Call it the gap the appeal never sees. Every attack you log as one day is, in your actual week, closer to two. The headache ends and the postdrome starts, and the postdrome is where a real share of the lost function lives: the fatigue, the word-finding trouble, the residual photophobia that keeps you off screens. Insurers count attacks. Bodies run cycles. The unit of measurement and the unit of suffering have never lined up, and the mismatch is quietly working against you.

Why 'headache days' is the wrong unit

The migraine-day count exists because it's easy to administer, not because it captures disability. A plan can define a headache day, tally it, and audit it. Postdrome resists all three. It has no single pain score, it blurs into the next day, and patients, exhausted, rarely log it. So it drops out of the record, and what drops out of the record drops out of the decision. The result is an appeal that describes maybe half of why you can't reliably work, parent, or drive during a bad month. You're not exaggerating your disability when you feel worse than your chart says. Your chart is undercounting it, by design.

What the appeal actually asks for

Most commercial plans gate the CGRP class behind step therapy: you try and fail two or more older oral preventives first, and you clear a monthly migraine-day threshold. Chronic migraine, under the ICHD-3 criteria, means 15 or more headache days a month for at least three months. Every one of those thresholds is counted in headache days. None of them leave room for the hours after. In its 2024 position statement, the American Headache Society argued CGRP therapies should be first-line and that step therapy is no longer justified, but until your plan catches up, the day-count is still the lever.

How this plays out

Picture a straightforward appeal. Fourteen migraine days logged, two failed preventives documented, a denial on file for a gepant. The reviewer sees fourteen days of headache and a person who works full-time, and reads it as manageable. What the file doesn't show: after nine of those fourteen attacks, a full postdrome day where she left work early or couldn't drive. That's nine more days of impaired function, unlogged, because nobody asked and the app she used closed the entry when the pain score hit zero. Add them and the month isn't fourteen bad days. It's twenty-three. Same person, same month, a denial that might have gone the other way if the record had been complete.

Same person, same month, a denial that might have gone the other way if the record had been complete.

Document the whole cycle

You can't make an insurer count postdrome. You can make it impossible to ignore. An appeal that shows a continuous symptom timeline, headache into the fog and the photophobia and the recovery, tells a fuller story than a bar chart of pain-peak days. That's the gap we built Postdrome to close. The timeline doesn't end when the pain does, aura-mode keeps logging usable when you can't look at a bright screen, and the whole record exports as your data, not ours, ready to hand to a neurologist or attach to an appeal. Lifetime pricing, stored on-device, no subscription reading your health data. The days after the headache are still disabling. Now they're on the record.