Hi, I'm Shubhi, one of the co-founders of Burst. If you get migraines, this guide is for you.

Most people I talk to who manage migraines have spent thousands of dollars out-of-pocket on ice caps, supplements, devices, and other things that quietly help. Almost none of them realized those purchases were FSA/HSA eligible with a Letter of Medical Necessity (LMN). I'd rather you not be one of those people.

This is a quick walkthrough of what's actually eligible for migraines, how a Letter of Medical Necessity works, and how Burst handles the part most people get stuck on.

What FSA/HSA actually covers for migraines (in plain English)

The IRS rule is simpler than most people think. If a product is being used to "diagnose, treat, mitigate, or alleviate a specific medical condition," it can be paid for with FSA/HSA dollars. Migraines are a recognized medical condition. So a wide range of products that help you manage them qualify, even though they aren't drugs and aren't prescription-only.

The catch is documentation. For products that have wellness uses (a supplement, an ice cap, a weighted mask, a wearable), your FSA/HSA administrator wants to see a Letter of Medical Necessity. That's a short note from a licensed clinician saying the product is being used to treat a specific condition (in this case, migraines). With the LMN attached to your receipt, the expense is reimbursable.

Two things worth knowing up front. The fee for getting an LMN is itself FSA/HSA eligible, so you can pay for it with your FSA/HSA card. And if our clinician decides your situation doesn't qualify for an LMN, you get a full refund. You're never out the money if the LMN doesn't come through.

Categories of migraine products often eligible with an LMN

These are the categories I see most often in real Burst LMN requests for migraines. Brand examples are illustrative, not endorsements, and not affiliate. The point is that the LMN works the same regardless of where you buy.

Cold therapy and ice caps

Cold caps and migraine-specific ice wraps (Headache Hat, Magic Gel, Mediviz, Theraice) are some of the most-requested migraine products on Burst. They're cheap, they actually help during an attack, and most people don't realize they're FSA/HSA eligible because they look like a wellness product. With an LMN that names migraines as the condition, they qualify.

You can buy these on Amazon, at Costco, on the brand's site directly, or at Best Buy. The LMN works the same either way.

Neuromodulation devices (Cefaly, Nerivio, gammaCore)

Neuromodulation devices use mild electrical or magnetic stimulation to interrupt or prevent migraine signaling. Cefaly (forehead-worn), Nerivio (upper-arm-worn, app-controlled), and gammaCore (vagus-nerve stimulator) are all FDA-cleared for migraine treatment or prevention.

These are higher-priced devices ($300 to $700+ range) where FSA/HSA reimbursement matters most. They're also where the most FSA/HSA dollars get left on the table because people assume "device = needs a prescription." With an LMN, they're reimbursable, and a single LMN covers the device plus replacement pads or consumables for the same condition for 12 months.

Weighted eye masks and headache pillows

Weighted and contoured eye masks (Manta, Nodpod, Drowsy, Tempur-Pedic-style) get used during migraine attacks to reduce light sensitivity and apply gentle pressure. Headache pillows (cervical traction pillows, contoured neck pillows) are commonly used for migraines that have a cervicogenic or tension-driven component. Both qualify for reimbursement with an LMN that names migraines as the underlying condition.

Magnesium, riboflavin, CoQ10, and other migraine supplements

The American Headache Society and AAN have published guidance on supplements with evidence for migraine prevention: magnesium (especially glycinate or oxide), riboflavin (vitamin B2), CoQ10, and feverfew are the most commonly cited. Melatonin is also frequently used for sleep-related migraine triggers.

Supplements are the category where FSA/HSA users most often get stuck. Without an LMN, your administrator will reject a supplement claim. With an LMN naming migraines as the condition the supplement is treating, the same purchase is reimbursable. One LMN covers the same supplement (any brand) for 12 months.

Blue-light and FL-41 glasses

For people whose migraines are triggered or worsened by light (especially fluorescent or screen light), FL-41 tinted lenses and blue-light filtering glasses (TheraSpecs, Axon Optics, Felix Gray) are often part of the management toolkit. These are eligible with an LMN. Prescription versions of these glasses are eligible without an LMN as standard prescription eyewear, but the non-prescription versions need an LMN.

Red-light therapy

Red-light therapy panels and wearables (Joovv, Mito Red, Hooga) are increasingly used for migraine management, especially for people who get relief from photobiomodulation. The category is FSA/HSA eligible with an LMN. Red-light is one of the higher-ticket categories ($150 to $1,500+) where the LMN math makes the most sense.

Ergonomic and posture

If your migraines have a tension or posture component, the ergonomic category opens up. Standing desks, ergonomic chairs, lumbar supports, monitor arms, and posture trainers (Upright Go) are often eligible with an LMN that names migraines as the underlying condition. Your administrator will want the LMN to specifically connect the product to the condition (which is what we write).

Sleep tools

Sleep disruption is one of the most common migraine triggers. Sleep tracking wearables (Oura, Whoop, Apple Watch), white-noise machines, sleep masks, and sleep-specific supplements often qualify with an LMN. The Oura Ring and other sleep wearables also have their own deeper guide on Burst if you want a single-product walkthrough: see Letter of Medical Necessity for Oura Ring & Wearable Health Devices.

How Burst gets you reimbursed (3 steps)

Step 1: Request an LMN at app.getburst.com/request-lmn

It takes under 5 minutes. You list the products you want covered, you describe the condition (migraines, in your case) and how the products help. You upload any supporting context if you have it (a doctor's note, a prior LMN, anything). You don't need to.

Step 2: A Burst clinician reviews and signs

Turnaround is under 24 hours, often faster. A licensed clinician on our network reviews your request. If your situation qualifies, you get a signed LMN PDF in your inbox. If it doesn't qualify, you get a full refund. You're never out the money.

Step 3: File the LMN with your administrator

Log into your FSA/HSA administrator (HealthEquity, Optum Financial, WEX, Inspira, Lively, whoever handles your plan). Upload the LMN plus your receipt. Hit submit. Reimbursement usually lands in your account in a week or two.

If you've never filed before, the Burst team wrote a short walkthrough that covers the most common administrators step-by-step: How to file your LMN for reimbursement.

We don't care which brand or store you buy from. The LMN covers the product, not the storefront.

One LMN, 12 months, any store

This is the part that catches people off guard. A single LMN from Burst covers that product (or product category, depending on how it's written) for 12 months. Once it's approved, you can keep buying the same magnesium, the same Cefaly pads, the same ice cap, all year, and keep using your FSA/HSA for them.

If you're someone who manages migraines across multiple categories (supplements plus a device plus an ice cap plus a sleep tool), you can request another LMN that covers those products or services too.

People I talk to who manage migraines tend to shop across many places. Amazon for the ice cap. Costco for supplements. Direct from the brand for the device. Best Buy for the wearable. The LMN doesn't care where you bought it. It cares about the product and the condition.

FAQ

Are migraine ice caps FSA eligible?
Yes, with a Letter of Medical Necessity. Ice caps and migraine cold wraps are not eligible by default because they're sold as general wellness products, but with an LMN that names migraines as the condition, they're reimbursable from your FSA/HSA.

Is Cefaly FSA/HSA eligible?
Cefaly is FSA/HSA eligible. Most users still find that an LMN smooths the reimbursement process, especially with administrators who flag medical devices for additional documentation. The same applies to Nerivio and gammaCore.

Are migraine supplements (magnesium, riboflavin, CoQ10) FSA eligible?
Supplements are FSA/HSA eligible with an LMN. Without one, your administrator will reject the claim because supplements have non-medical uses. The LMN documents that the supplement is being used to treat migraines specifically.

Can I use my FSA card directly to pay, or do I need to file for reimbursement?
Either works. Some retailers (FSA-certified storefronts) accept your FSA card at checkout for pre-approved categories. For most LMN-eligible purchases, you'll pay out-of-pocket and file for reimbursement after with the LMN attached. Either path uses the same LMN.

What if my administrator rejects the claim?
Administrators occasionally request additional documentation on first-time LMN submissions. If that happens, reply to your administrator with the LMN PDF Burst sent you and a copy of your receipt. If they still reject the claim, email support@getburst.com and we'll help you appeal.

How long does Burst take?
Most LMNs are reviewed and if approved, signed within 24 hours of request.

Does it have to be a doctor I already see?
No, Burst connects you to a licensed clinician on our network. You don't need to be an existing patient.

Is the LMN fee itself FSA/HSA eligible?
Yes. The fee for the Burst LMN request is an eligible medical expense, so you can pay for it with your FSA/HSA card.

Stop paying out-of-pocket for migraine management

If you're managing migraines and shopping across multiple brands or stores for things that help, I'd rather you stop paying out-of-pocket for purchases your FSA/HSA would cover. Get an LMN from Burst in under 5 minutes. If our clinician doesn't approve it, you get a full refund.

Request my LMN →

If you're not sure whether something specific qualifies, hit reply on any Burst email or write to support@getburst.com. I read every email myself. I'd rather sanity-check for you up front than have you guess.

Thanks,
Shubhi
Co-founder at Burst