Migraine is a debilitating condition that affects more than a billion people globally, making it the world’s third most prevalent illness. And it’s far more than just a bad headache since migraine can manifest itself not only as brutal head and body pains, causing dizziness, nausea, visual disturbances, brain fog, and even numbness or tingling in the face and extremities.
Despite such severe symptoms, many people put off going to the doctor, leave the migraine untreated, or opt for treatments that are not effective. These individuals often lack vital information or a proper diagnosis and meet with an empathy deficit among employers and colleagues. But thankfully, after decades of apparent stagnation, targeted treatments have emerged to drastically reduce their suffering while public awareness of the condition continues to grow.
Cove, the only telehealth company dedicated to migraine, has rapidly grown to offer more than 20 clinically proven migraine treatments. The company’s selection includes acute and preventative medications, as well as dietary supplements. A licensed doctor makes sure you’re getting the right treatment for your needs, and Cove delivers your therapies directly to your door every month.
Cove can meet the needs of most migraine patients with a wide assortment of targeted treatment options and a continued push to add the latest therapies to their offerings. Cove’s prices are among the best, and the process for signing up, getting evaluated by one of their migraine specialists, and receiving your medicine by mail is fast and simple.
- Wide selection of expert-recommended, FDA-approved treatments
- Effective prescription treatments for both acute pain relief and prevention
- Personalized treatment plans based on your specific needs and migraine history
- Ongoing access to a board-certified migraine specialist
- Reliable delivery that ensures you never run out of medication
- Not designed to treat certain other types of headaches, like cluster headaches
- Not useful if your migraines aren’t frequent enough to require monthly medication deliveries
- Insurance isn’t accepted unless your doctor prescribes certain medications, such as Nurtec ODT
- Only offers one preventative CGRP monoclonal antibody treatment
- Not for patients under age 18
Cove is a telehealth company with a single focus: helping people with migraine. They offer a slew of cutting-edge treatment options, from daily pills and monthly injections to dietary supplements, all conveniently delivered by mail. The system is designed for people who suffer either acute or chronic migraine. It is particularly good for patients without insurance and those whose plans don’t cover the totality of their needs or whose locations limit their access to specialists.
Cove might not be ideal for patients with migraine-adjacent disorders like cluster headaches or those who have found success with certain in-person treatments like Botox or physical therapy. While Cove provides fast and reliable shipping, it’s important to note that they don’t ship outside the United States. Also, there are currently nine US states where telemedicine restrictions make it impossible for the company to operate.
We judged Cove on several criteria, including their range of treatment options and their quality of support, emphasizing any aspects that could provide substantial relief, or significant distress, to a migraine sufferer.
While Cove requires insurance to access a few of its treatments, uninsured patients will notice dramatic savings on other medications, which often cost less than typical copays. This can really help migraine sufferers who struggle to hold down jobs needed to secure health insurance. Insured patients may also see savings compared to their current plans, but it’s important to compare, especially as certain medications offer savings cards and coupons outside the Cove system.
Your first month of Cove, which includes consultation with a specialized medical professional, will cost between $30-$50. After that, it’s only $10/month for ongoing unlimited messaging access to your doctor for any questions or concerns that might arise. Aside from this, the only costs incurred are the prices of your treatments, most of which cost $12/month, with the ability for outside insurance to intervene where certain prescription medications would otherwise be prohibitively expensive. Most Cove users pay around $20 per month whether their prescription is for acute or preventive treatment.
One of the best things about Cove’s consultation experience is its speed, especially when compared to the long wait times to see a specialist in-office — if you can even find one near your home. And the actual consultation is thorough, noticeably a bit longer than many other online medical consultations for other disorders. Given the wide array of potential causes for and symptoms of migraine, this level of specificity helps ensure that you receive an initial treatment plan with the greatest odds of success.
Some aspects of an individual’s migraine experience can be tough to explain without typing long, detailed descriptions. For many sufferers, this amount of screen time can be a trigger in and of itself. That’s one of the reasons that Cove allows you to upload videos to accompany your questionnaire responses, allowing you to go into detail more quickly and easily.
So long as you continue to pay the $10/month for doctor access, you’ll be able to receive prescriptions for anything on Cove site and contact your doctor any time with questions or concerns. Most doctors respond quickly, but many of Cove’s physicians are sought-after specialists with relatively long patient rolls, so there can be a delay of up to two days in some cases. In the event of a serious medical emergency, of course, a trip to the ER or local urgent care may be necessary.
When dealing with Cove’s doctors, one thing is certain: they’ll listen. Any migraine patient has endless stories of primary care doctors rolling their eyes at the mere mention of migraine. This indifference might not be too surprising when you consider that, according to the WHO, the average medical student globally will receive just four hours of instruction regarding headache disorders. But Cove doctors, being migraine and headache specialists, have seen and heard enough to know that their patients are reporting sincere symptoms, and they’ll meet you with a level of knowledge, empathy, and understanding you might not find elsewhere.
Cove provides a generous range of options for the prevention of occasional and chronic migraines, as well as the treatment of acute attacks. Still, the variety is a bit inconsistent when you break down each of those approaches into their attendant drug classes. For example, Cove offers a handful of different triptans intended for acute treatment, like Imitrex and Zomig, but only one CGRP antibody treatment as a preventative. All of the company’s other preventative treatments target migraine as an off-label benefit and are technically classified as antidepressants, anticonvulsants, or blood pressure medications. Still, for a single telemedicine provider, the assortment is impressive.
We measured Cove’s efficiency by how complicated it is to sign up, complete a consultation, and receive medicine. We also looked at how long it takes to contact a doctor through their messaging interface or get a person on the phone if you have any immediate questions about your treatment plan.
It usually takes less than two weeks to receive your first order in the mail, including time spent on your consultation and developing your treatment plan. If you already happen to know what non-prescription treatments you want to order, you don’t even need to speak to one of their doctors before doing so. That means things like supplements can be acquired quickly, easily, and at a relatively low cost.
Getting started with Cove is pretty straightforward. Here’s how the process works:
Step 1: Take the quiz
This short quiz is less about finding out whether Cove is right for you than it is about setting up your account and establishing a baseline of information before a consultation with a Cove doctor. Almost any combination of answers to its questions will lead you to a page where you can start your subscription and begin your consultation.
Step 2: Complete an online consultation
The majority of your consultation will be in a simple question-and-answer format. You’ll also have the opportunity to upload videos to communicate more complex aspects of your experience to your doctor, which can be a big help for patients who might have a migraine triggered by too much screen time and typing.
Some things to think about before your consultation:
- Do you have any symptoms that precede the onset of pain, like visual disturbances or trouble with speech and coordination?
- Where in your body is the pain most intense or most likely to occur?
- Which medications (over-the-counter or prescription) do you use to manage the pain now, and how much/how often do you take them?
Try to get a handle on a family history of migraine and any other significant disorders that might be hereditary and may exacerbate migraine conditions, like immunodeficiencies or food allergies and intolerances.
After you submit your consultation materials, a doctor will review them — typically within a few hours but in no longer than 48 hours — and contact you with a suggested course of treatment.
Step 3: Begin treatment and adjust as needed
After your consultation, you can approve the plan as suggested by your doctor, inquire about alternatives, or add any non-prescription supplements to your order that you think might be helpful. Cove will ship your treatment directly to you, and most orders arrive within 3 to 5 days. Shipping is relatively inexpensive at just $3/order, and some recurring shipments are also eligible for free shipping.
As your treatment proceeds, you may find the need to make a change in your treatment plan. Your $10/month subscription gives you unlimited messaging access to your doctor with questions and concerns, so you can make those adjustments whenever you need.
Do Cove treatments have any side effects or other downsides?
There are possible side effects from treatments offered by Cove, whether or not they require a prescription. These may be more pronounced in certain preventative medications that have the off-label benefit of managing migraine. During your initial consultation, Cove doctors will identify safe treatments that are not contraindicated for you given your symptoms, medical history, health conditions, and current medications.
If the doctor recommends treatment, you’ll also be able to review information about how available drugs work and whether there are potential side effects. As you begin and continue treatment, you will be able to watch for those side effects or any other questionable experiences and contact your doctor at any time.
A note about preauthorization
Cove currently offers Emgality and Nurtec ODT, both of which require preauthorization before your insurance company will cover them. Without insurance, these treatments can be prohibitively expensive. All insurance carriers and individual plans will have their own rules for preauthorization, which may include:
- A coverage agreement between your provider and the pharmaceutical company
- Evidence that a patient’s condition is severe enough to warrant the use of these drugs
- A timeline showing that a patient has not attained sufficient relief from other interventions available on the market
For Cove customers, especially those who are new to prescription migraine treatment, you might have to try a few other preventative or acute medications before you can access Emgality or Nurtec at a reasonable cost. And the preauthorization process itself can be a lengthy one, even if you’ve already exhausted all other treatment options. Fortunately, Cove has a dedicated preauthorization hotline to help you and your doctor navigate your insurance company’s needs and get you help as quickly as possible.
The variety of available migraine treatments has exploded in recent years. Many of these treatments specifically target migraines, unlike the anticonvulsants and antidepressants previously prescribed for the occasional off-label efficacy. Those can also be effective for certain patients, however, so Cove offers a bit of everything.
Cove’s product lines for migraine treatment fall into three categories:
- Acute medications for pain and nausea relief
- Preventive medications that patients take periodically to prevent migraine from happening or at least reduce the severity of migraine when it does occur
- Dietary supplements that evidence suggests are useful in combating migraine
Acute medications work best to relieve migraine symptoms as soon as an attack begins and are most effective if taken during a prodrome phase or at the onset of pain. Cove’s prescription acute medications include triptans, NSAIDs, gepants, and anti-nausea medications.
Be sure to discuss the potential for overmedication migraine with your doctor, as the overuse of many acute medications can actually worsen migraine over time.
NSAIDs (non-steroidal anti-inflammatory drugs) are common pain relievers that include drugs like aspirin, ibuprofen, and naproxen. You might know them by brand names like Advil, Aleve, Motrin, and others. While some NSAIDs are available over the counter, others require prescriptions.
Motrin, and others. While some NSAIDs are available over the counter, others require prescriptions.
Triptans are tryptamine-based medications used to treat both migraine and cluster headaches. By stimulating the serotonin receptors in your brain, this type of medication decreases inflammation and constricts your blood vessels to produce effective relief within 30-90 minutes. Some patients experience nausea as a common side effect of triptans.
Gepants (small molecule CGRP antagonists)
CGRP (calcitonin gene-related peptide) is a substance that the body releases around the brain. Research suggests that migraine pain may be related to this CGRP release, which inflames the brain’s meninges (the outer membrane covering the brain).
Doctors usually prescribe gepants like Nurtec ODT to patients who don’t find much relief from triptans, or who can’t tolerate them for one reason or another. At the time of this writing, Nurtec has been approved for use as a preventative when taken every other day. Unfortunately, Cove doctors can currently prescribe it only as an acute treatment that arrives as a monthly eight-pill allotment. The company is actively working with insurance providers to offer it as a preventative as soon as possible.
Migraine sufferers often experience aura, which is a disturbing and sometimes completely debilitating visual phenomenon often accompanied by nausea and even speech difficulties. Nausea is also a common side effect among triptans. Cove’s anti-nausea medications, taken alongside acute pain relievers, help people overcome this double-whammy effect.
These are medications you take regularly to reduce the occurrence or severity of migraine attacks. Cove offers a monoclonal antibody CGRP antagonist, beta-blockers, anticonvulsants, and antidepressants that are clinically proven to reduce the frequency of migraine headaches.
Monoclonal antibodies (large molecule CGRP antagonists)
Delivered in high single doses and capable of sustaining relief in many patients for one to three months, large molecule CGRP antagonists like Emgality are some of the most effective preventative offerings on the market and are among the few that specifically target migraine. They are administered via autoinjector and interfere with CGRP’s release and effects to reduce or stop inflammation and pain.
Emgality is currently the only CGRP antagonist injection that Cove offers, despite the existence of similar drugs like Aimovig and Ajovy, each of which affects individual patients a bit differently. The company has not publicly committed to expanding offerings in this specific drug class, but they do claim to work consistently to increase the number of available therapies for their customers across the board.
Beta-blockers are medications — often prescribed for cardiovascular issues like hypertension — that block adrenaline from binding to beta receptors, thereby keeping your heart rate and blood pressure low. Examples include propranolol and metoprolol.
Typically prescribed to prevent conditions like seizures, anticonvulsants have shown to be effective for those with migraine, as well. They soothe the excited nerve cells in your brain, which otherwise could be triggered and set off the series of events that cause a migraine.
A drop in serotonin levels may play a role in migraine. Antidepressants like amitriptyline regulate serotonin levels and, for some people, keep serotonin at a healthy enough level to prevent migraine.
Certain dietary supplements successfully reduced migraine frequency in clinical trials, including magnesium, CoQ10, and riboflavin. Cove also offers a proprietary blend of these three supplements called Cove Beam. You can order any of these through Cove without having to complete the consultation or pay a $10 monthly subscription.
Supplementing with magnesium is beneficial for some migraine sufferers, helping to prevent migraine or reduce migraine severity. Magnesium plays a role in disrupting the wave of nerve signals that set off a migraine. But it’s also a vital nutrient for cardiovascular health, and a surprising number of us don’t absorb sufficient amounts of magnesium from our diet.
CoQ10 (or coenzyme Q10) reduces levels of CGRP, which are elevated during a migraine. By reducing the CGRP levels in the body, it seems CoQ10 supplementation can be an effective preventative measure for some with migraine — studies also suggest this to be true. Patients without outside insurance or those who have trouble receiving preauthorization for Emgality can use CoQ10 instead, though its efficacy is likely significantly less than prescription CGRP antagonists.
Riboflavin (also called vitamin B2) has been shown to help prevent or reduce the severity of migraine at very high doses (which are safe to consume since the kidneys remove excess B-vitamins from the body through urination). The mechanism by which B2 helps prevent migraine is not currently known.
This is Cove’s proprietary blend of magnesium, CoQ10, and riboflavin, with a small amount of iron, as well. Cove Beam simplifies the process of taking the three other supplements individually and is especially good for patients who don’t like taking pills, as it comes in a powder form that absorbs into water or any other drink. Keep in mind, however, that it costs $5 more than you’d pay for the three supplements on their own.
Remote electrical neuromodulation devices
It is worth noting that, relatively recently, Cove suspended the offering of a neuromodulation device called Nerivio. This and similar devices like Cefaly and Gammacore are designed to stimulate responses in the nervous system that can mitigate migraine at the onset. They are popular for being non-invasive, non-pharmaceutical options. Nerivio, in particular, is sought after for being discreet; users can wear it unobtrusively beneath their clothes, unlike other devices.
It’s unclear at this time why Cove no longer offers any form of neuromodulation, but when they had Nerivio on their site, it was not covered by insurance. Recently, however, Nerivio has undergone an extensive regulatory process to reduce its cost to patients through insurance coverage. That process is ongoing, as some carriers and plans will presently cover Nerivio and others won’t, but it could take a big bite out of the current $10/use price tag. Of course, Cove’s offerings are always evolving, so perhaps, once the insurance issue is settled, Nerivio may return to Cove with the option for insurance coverage.
Cove isn’t the only option for migraine sufferers looking to telemedicine for help, though it is the only one that is exclusively designed to cater to migraine patients. Thanks to everything from pandemic restrictions to a shortage of specialists — just one migraine specialist nationwide for every 80,000 patients — people with migraine and other conditions are readily looking to online interfaces for fast and reliable help.
Companies like Nurx, Alpha, and Lemonaid have expanded their telemedicine offerings in recent months to accommodate migraine patients, as well, with varying results. Because Cove is a dedicated migraine resource, their specialized care can be a bit more reliable than some others, especially when it comes to ensuring the knowledge base and experience of their migraine specialists. And many of these other companies have far fewer migraine specialists among their ranks than Cove does.
One advantage some other providers have over Cove is that their broad reach gives them more leverage and experience in dealing with insurance providers and pharmaceutical companies. This reach is why Nurx, for example, can offer a few more CGRP antagonist injections than Cove can.
Costs among these companies will vary, with some only operating at an effective rate if you have insurance. And while many of the medication costs are comparable, the unlimited messaging access to a migraine specialist with Cove’s $10/month subscriptions is very valuable. Considering these factors, we believe that Cove is the ideal place to start for anyone looking to tackle their migraines head-on.
Migraine triggers are an incredibly diverse group of substances, activities, or environmental conditions that migraine sufferers identify as inciting elements, reliably initiating or exacerbating a migraine. Here are just a few examples of things that can commonly trigger migraine:
- Certain drinks like wine or coffee
- Foods like aged cheese and high-sodium dishes
- Changes in daily behavioral patterns like skipping a meal or getting less sleep
- Specific smells or strong scents in general
- Chronic or intense stress
- Jarring stimuli like bright lights or loud noises
What triggers one person’s migraine may have no effect at all on someone else, which is just one of the reasons that having regular access to your doctor is useful.
Some patients are lucky, and they can hop on a specific medication and see a dramatic decrease in their migraine symptoms in little to no time. Many others will require a multi-faceted approach, however. This might include making adjustments to their diet or the ergonomics of their workstation and combining preventative therapies with acute medications and dietary supplements to find sustained relief.
Many people, including those who have lived with migraine for years, might not realize that a migraine attack consists of multiple phases. Recognizing these phases and the transitions between them can be vital for providing yourself with the best chance of enduring or even beating back an attack.
The prodrome phase is the opening volley of a migraine attack, setting in anywhere from a few hours to a few days before the onset of pain. It can consist of symptoms that might be hard to differentiate from reactions to various other stimuli, so you should be on the lookout for any or a combination of these to help you identify a prodrome:
- Problems with concentration
- Sensitivity to light and sound
- Difficulty speaking and reading
- Depression and irritability
- Increased urination
There are other potential prodrome symptoms, to be sure, so it’s best to keep a journal you can share with your doctor. This can help you identify recurring experiences you have just before a migraine hits. If you can successfully identify a prodrome, you can time the use of triptans and other acute medications to have the greatest effect.
Aura is the term used to describe visual disturbances that immediately precede a migraine attack, usually between 5 minutes and an hour before the onset of pain. Patients report everything from shimmering lights and geometric patterns to blurred vision and even temporary blindness.
Keep in mind that not all migraine patients experience aura, so don’t think that your headaches aren’t migraines if aura doesn’t occur for you.
The headache phase is what most people associate with migraine, as intense pain can make it impossible to go about daily activities. Pain can occur just about anywhere in the head and neck region, but it can also express itself in other parts of the body. Some patients will suffer nausea and disorientation, and all of these symptoms can last for hours or days at a time.
The postdrome phase is often referred to as the migraine hangover, and about 80 percent of patients report its symptoms. Patients might find themselves fatigued, irritable, and easily confused. Brain fog can be significantly pronounced during this phase. The postdrome can be particularly dangerous for patients with severe chronic migraine resulting in more than 15 migraine pain days each month; sensitivity to stimuli during the postdrome can make these patients more susceptible to their triggers and can make it easy for them to fall into a chronic migraine cycle.
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We extensively test each health service we review, including Cove. We try our best to give you, our readers, an unbiased exploration of at-home health services, free of marketing jargon or gimmicks. We evaluate the service based on our adherence to quality, the latest medical evidence and health standards, and a simple question: would we buy the product or service ourselves if it weren’t part of our job, and would we recommend it to family and friends?
Additionally, this review of Cove, like all health-related content on this website, was thoroughly vetted by one or more members of our Medical Review Board for accuracy.