Moving to Italy with Chronic Illness

There is no blueprint for moving abroad with chronic illness.

There are no guidebooks or Instagram accounts that combine these two realities. Inspirational travel-related stories and guides are often about confronting our fears, stepping outside our comfort zones, and taking that first step to “change our lives.” But it’s tough to connect with those uplifting, rah-rah stories when your day-to-day is spent managing and treating an often-disabling medical condition. Those stories are written for other people, people who aren’t sick most of the time.

So, for many years, I didn’t believe moving to Italy was a realistic possibility for me. Even visiting was unlikely because of the severe migraines air travel triggers for me.

Still, I did end up moving to Italy with a chronic illness.

It wasn’t easy, but it turned out to be much more possible and successful than I expected. But I wish I could hear more stories of people with chronic illness or chronic pain having adventures while still being sick. Not stories of people searching for a cure or overcoming pain or struggling with pain, just stories of people living meaningful lives.

So, in case anyone else out there with chronic illness or chronic pain is wondering what it’s like to move abroad (and whether it’s even possible), this blog post is for you.

I’m going to share my story of moving to Sicily with chronic migraines, along with the details and logistics of what helped make the move successful. Because as anyone with a tough-to-treat chronic condition knows: details and logistics are everything!

Moving to Italy with Chronic Illness Felt Impossible and Impractical

When Marco and I moved to Sicily, I'd been dealing with chronic migraines for nearly 20 years. The "chronic" part of chronic migraines means you have 15 or more migraine days per month. Treatment usually involves a medicine cabinet of preventive medications that you take every day in hopes of reducing migraine frequency.

In chronic migraine groups, most people’s biggest concerns (including my own, before I moved to Italy) revolve around staying employed, covering doctor and prescription copays, battling insurance, and attempting to participate fully in our own lives (friends, family, hobbies, things that bring joy, etc.).

When people talk about travel, it’s about things like how to manage migraine triggers while away from home, how to deal with migraines while traveling (and the guilt of disappointing our families when we inevitably get a migraine), where and how to find a doctor if needed, and whether we’ll have issues with airport security when hauling all of our medications with us.

So, while packing up your life and moving to Italy SOUNDS romantic, and even brave, for someone with chronic migraine like me, it required a LOT of very mundane lists, research, and planning.

All that planning paid off. Here's me touring my parents around Sicily this sumer!

Context: Let's talk migraine treatment for a minute.

Migraine medications come in two varieties: preventives and acute treatments.

Preventive medications are theoretically supposed to help reduce the frequency of your migraines. But, unlike treatments for common conditions like high cholesterol or blood pressure, migraine preventives are a bit of a grab bag. Until very recently, the majority of migraine preventives were designed to treat other conditions and are often used off-label (meaning they haven’t been officially approved to treat the condition). Migraine preventives I've taken include Alzheimer's medications, epilepsy treatments, blood pressure medications, anti-depressants, and Botox (among others).

Usually, for treating chronic migraines, you start on a medication and increase the dosage (under your doctor's care) until your migraines get better, get worse, or the side effects become intolerable. Each time you add a new med, you usually have to stay on it for three or more months to see if it's helping or hurting.

Basically, you're a medication guinea pig.

More recently, the first class of medications designed specifically to prevent migraines came out, called CGRP inhibitors. These medications are usually administered as a monthly injection, a quarterly infusion, or a series of injections. At the start of the pandemic, I finally went on my first CGRP inhibitor and, for 12 months, it was life-changing. And then it stopped working. I switched to another CGRP inhibitor, which (you guessed it), worked for about 12 months.

Also, these new CGRP inhibitors are VERY expensive. So even if you get diagnosed with chronic migraines today, you’re still going to have to go the medication guinea pig route until either it works or it fails—and then you can try the new meds.

In addition to preventives, those of us with migraines also need acute treatments: the medications we take when an attack starts.

For me, I have a standard protocol to take when I get a migraine (a triptan and NSAID), and three different protocols for treating intractable migraines (migraines that last three or more days) without having to go to the ER.

So, that's a LOT of medications to think about.

But these combos of meds are what enable most of us to have even a baseline level of functionality and independence.

On top of all the meds, you then add supplemental treatments: special diets, special pillows, supplements (with good research), chiropractors or acupuncturists, meditation (yep), devices (non-invasive neuromodulation devices), and whatever random hacks you've personally discovered or devised (there is a McDonald’s hamburger migraine hack that even made the news in 2025).

Keep in mind that you and your neurologist are likely the ONLY TWO PEOPLE who know all the meds and treatments you are on. Your spouse doesn't know. Your best friend doesn't know. Your primary care doctor raises their eyebrows when they hear the full rundown.

So in addition to taking all these treatments, you also must track and understand them all. This is super important if you want to do something like move to Italy.

Chronic migraine treatment makes Italian bureaucracy seem BREEZY.

Now, imagine you want to move to Italy AND you have chronic migraine that requires managing that rolling cast of treatments.

One American in Italy that I know, Mark Hinshaw, has counted up more than 100 distinct bureaucratic and logistical activities that must be completed when moving to Italy. These tasks often involve getting yourself to some bureaucratic office (the comune, the questura, the police station, etc.) and waiting around for an unknown amount of time until you either complete the task or get instructions on the next step needed to complete the task. (If that sounds frustrating, imagine doing it all with a bad migraine.)

Now, take those 100 tasks and add managing chronic migraines. You’re not just on a clock to get your immigration paperwork in. You’re on a clock to get access to the medications and treatments that allow you to function enough to get out of bed most days.

When I was living in the US, multiple times I’d have insurance companies decide out of the blue to deny treatments or require new prior authorizations. This would mean delays in access to the medications that my body relied on—which would generally result in an intractable migraine that lasted until I could resume treatment and then until the treatment took effect. This could sometimes be weeks or months.

So, I was already very familiar with the practical cost of interruptions in care. That meant I had to avoid interruption in treatment at all costs—because I would also be dealing with those 100+ bureaucratic and logistical activities.

There were a couple other complicating factors to juggle:

• I knew that it would take multiple months to get access to my current medication protocol through the Italian health system. The timeline is impossible to know in advance and varies by region, by city, and by the type of visa or citizenship that have allowed you to relocate in the first place. 

• The international medical insurance that I could find DID NOT cover pre-existing conditions. That meant any costs related to migraines would be self-pay (aka paid out of pocket).

• Medications like CGRP inhibitors, which I took at the time, were at least $700-800 per month if purchased out of pocket (prices were similar in the US, UK, Italy, and other EU member states—because yes, I checked).

Looking back, it’s a bit daunting. I can see why I didn’t think moving to Italy was feasible with chronic illness.

Still, for all the reasons that people move to another country—more opportunity, a better way of life, being close to family, etc.—I was determined to do it. But it took a year of planning and preparation.

More than just meds: You bring any past medical trauma, fear, and anxiety with you, too.

One other thing I’ve never read about is how all that medical trauma you’ve stored up—being sick, being scared of being sick, struggling with treatments that don’t work, fighting insurance companies to get access to treatments that do work—you bring all that with you.

You might be in a new country, but every time you go to fill a prescription, you feel that zing of fear and anxiety. Will insurance deny this med? Will I have to choose whether to go into debt again to get this treatment? Is this the month the medication stops working?

In my chronic migraine story, I’ve dealt with all of those. Early on, I racked up $10,000 in medical debt on my credit card (my salary at the time was $25,000 living in NYC so…). I took one insurance company to the state board of appeals to get coverage for a treatment. And the magical CGRP meds all stopped working after 12 months for me.

Insurance companies would also try to control costs by making it so you couldn’t access a full month’s worth of acute treatment medications at once. Imagine that you need 10 tablets a month of an acute medication. Your insurance company will only allow you to get 4 tablets at a time, and each time you must pay a new copay. So, to get your 10 tablets, you’re going to the pharmacy three times a month (standing around, waiting in line, discovering the prescription isn’t ready yet, etc.) and paying three copays. And if you get a run of bad migraines and your doctor wants to put you on a special protocol? You better have stockpiled those meds or else you’re paying out of pocket.

I hated changing jobs because it would mean having to start all over with a new insurance plan: new physician networks, new prior authorizations, new preferred medications, new hoops to jump through before I could get appropriate care. I often stayed in bad jobs just because the insurance was pretty good.

While most of my medical trauma came from not having access to care (or having to make really hard decisions about how much care I could afford), many other people with chronic conditions also experienced years of not-great medical care. Doctors dismissing symptoms or telling them it was all in their heads. I was lucky in that it only took me three tries to find an amazing neurologist who recognized migraine symptoms I didn’t even know were happening (like cognitive impairment during migraines).

Yes, not every condition I’ve had was quickly or easily diagnosed (more on that in future posts). But I mostly avoided the “there’s nothing wrong with you, it’s all in your head” experience that many people with invisible illness struggle with.

The reality, though, is that if you’ve dealt with chronic medical conditions, you’ve likely experienced some trauma along the way—from the difficulty of the condition, the effort of getting the right care for it, or the challenge of navigating a world and workplaces that aren’t always accessible or compassionate.

And all of these experiences come with you when you move abroad, neatly packed between your socks and your pill sorter.

How I Prepared to Move to Italy with Chronic Illness: What Worked and What Didn't

I spent 20 years working full-time as a nonprofit grant writer. That means I’m used to juggling deadlines, timelines, and paperwork. Even if I can barely get out of bed, I can still put together a work plan to meet a deadline. So that’s what I did.

Once we decided to move to Sicily full-time, I created a year-long timeline that covered managing ongoing care, creating backup plans for future care, and learning everything I could about how to navigate the Italian health system.

For logistics, these were the most helpful things I did before moving: 

1) “Stockpiled” medications so I had a six-month buffer. 

I did NOT want to be chasing down medications in a crisis state when we landed in Sicily. So, I set out to build up a supply of migraine preventive and acute medications that could last me at least six months after we moved. This would give me time to learn to navigate through the local system and change to equivalent medications calmly and thoughtfully.

I did a few things to “stockpile” meds—all of which involved knowing the US insurance system very well and following the rules very carefully:

• I refilled every prescription as soon as it was eligible. This meant a lot of trips to the pharmacy (shoutout to my best friend Jo who went to the pharmacy to pick up meds even when I could not).

• I paid super close attention to my prescription coverage provider’s rules—and made sure I always knew what could be filled when, what prior authorizations were needed, etc. I’d already had to do this for years to survive the often-inadequate health plans nonprofit organizations offer their staff.

• I talked to my neurologist about my upcoming move (she was very excited) and, for generic meds, we used Cost Plus Drugs to call in multi-month prescriptions that I could pay for out of pocket.

• I learned about manufacturer coupons and patient assistance programs—and used them whenever I could.

  
  

Note that if you are on medications that can’t be brought with you or are administered by a healthcare provider directly (such as a monthly infusion), then you’ll want to jump to the next step of doing research.

2) Researched local medication availability, equivalents, and prescriber processes.  

Before moving, I did not know WHICH of my medications were available in Italy and what the process was to access them.

Finding the answer is far more difficult than a quick Google search. AI summaries, random websites, and other search tools may be and often are INACCURATE.

Just because an AI tool or website on the internet says your medication is available in Italy, does NOT mean it is available!

To accurately confirm what medications are available and how to get them, you have a few options:

• Speak to a pharmacist in Italy (they know a LOT).

• Speak to a specialist in Italy who treats your condition.

• Find official government information about the medication—such as from the Agenzia Italiana del Farmaco (you can search the AIFA database directly from this page) and also the European Medicines Agency. Study this information very carefully and confirm regional variations in prescribing protocols (see below for how).  

• If you visit Italy or know someone living where you will be living, go to pharmacy and to specialists to speak to them in person (email won’t work, and these relationships will make your life and medical care much more manageable in the long run).

• If you visit or know people in Italy, ask them for referrals and about their experiences directly. They may know someone who knows someone who can help you find what you need. 

• Try to find which options may be available via private pay, while you wait for the public system (specialists and pharmacists are your source here, too). I did backup research on medication availability via private pay in the UK and EU member states, in case I needed something urgently or in case the Italian system proved slower than even my preparation accounted for. 

When researching medication availability, I found three tactics that absolutely do not work:

• Relying on AI results (often incorrect or misleading).

• Emailing people in Italy and expecting a response (just not how it works here).

• Believing search results or websites without confirming in official databases.

The research portion of your preparation will require some knowledge of Italian or at least the ability to search for official documents in Italian and translate those documents.

In my case, prior to moving, I was on two expensive specialty migraine treatments: Botox and a CGRP inhibitor called Ajovy.

In the US, accessing both of these medications requires having tried and failed cheaper generic medications first and then getting prior authorizations from insurance companies (which were always denied the first time, but eventually approved if your doc has good office admin staff).

I was most concerned about getting access to Ajovy, which was a relatively new medication still at the time. So, I searched and searched until I found information confirming that Ajovy was approved for use in Italy and covered as a treatment in the public system (subject to each region’s prescribing protocols). I then found an official document from Sicily describing the current prescribing protocol for the region. This included the types of doctors who could prescribe it (specialty neurologists in the public system) and the criteria needed to be eligible for the medication. The documents I found looked a lot like this and this. Not necessarily approachable at first glance, but I learned just enough to know the medication was available, that I would be eligible, and that I’d need to get referred to specific specialists (and have all my prior records in hand) in order to get the prescription.

This was enough information to make a plan (and a backup plan, too).

In other cases, I learned that the specific medication I was taking was not approved or sold in Italy, but there were similar medications available. That meant I would need to work with my doctor and pharmacist to find the right equivalent medication and be prepared for potential side effects when switching. (This is another reason why bringing a supply for a few months was crucial for me.)

In total, I discovered that three of my medications were not available in Italy, but the equivalents the local pharmacist helped me find worked just as well.

3) Researched migraine specialists in Sicily and Italy overall.

Using the same skills for researching medication availability, I also researched migraine specialists in Sicily and Italy. During the planning process, my neurologist in the US said: “Who knows, there might be different and better treatments available in Italy.” (Spoiler: My neurologist was right!)

Thanks to my neuro’s comment, I went into my specialist research with an open mind. And, when we moved, I had a list of doctors who I planned to speak with once I’d gotten through the initial immigration process.

One of the most important parts of creating this list, though, was that it helped me feel more confident during the move. I had all the pieces in place I needed to manage my condition short-term and long-term.

4) Printed and translated ALL my medical records, including medication and treatment histories.

In the US, a lot of records are now digital. Your scans, lab results, prescriptions, etc. all pop up in a patient portal for whatever practice or hospital network your doctor is in. Sometimes, that means you’re using multiple patient portals.

Here, there is a combination of fractured online systems and good old physical copies.

When you go see a doctor about a specific issue, you better have all relevant tests, scans, and medical history printed out and ready to hand them for review.

I did not know this in advance, but I’m a planner, and I’ve had to change specialists a few times in the US when changing jobs and needing to find new providers that would accept my insurance.

Regardless of country, every time you go to a new doctor for a chronic condition, they’re going to want to know what medications, tests, and treatments you’ve already had—otherwise they’re going to make you start all over. For some 15 years, I’ve held onto the original lab results from my first colonoscopy when I got diagnosed with ulcerative colitis (thankfully it’s mild and in remission).

You better believe that I brought those 15-year-old colonoscopy results with us when we moved.

I also printed out a comprehensive record of all the treatments I’ve tried for chronic migraine and the most recent and relevant notes from my neurologist. Then, Marco used a tool online to translate everything.

Before seeing my primary care doctor to discuss chronic migraine treatments, I put together a medical history folder including all relevant records in English and Italian. This made it much, much easier to get routed through my primary care provider to a general neurologist to the migraine specialist neurologist (who is the type of doctor who can actually prescribe specialty treatments like Botox or CGRP meds). It also made sure we avoided having to try medications that I’d already used and that did not work for me.

Since then, I’ve learned that at the end of a specialist appointment, the doctor will traditionally type and print a recap of the current status of your condition and any recommendations. You then add this document to your “condition” folder. At your next appointment, the same doctor or next-level specialist will read it along with any other prior records—but only if you bring them all in hard copy.

5) Learned Italian.

During the pandemic, while we were working remotely, I started studying Italian. I wanted to be able to speak to Marco’s father more easily (not realizing he would understand Italian but reply in Sicilian, a different language). I also wanted to pass the B1 Italian exam, so I could apply for Italian citizenship by marriage, since Marco was an Italian citizen from birth.

It turned out that speaking Italian was also essential to being able to successfully move to Italy with chronic illness. 90% of medical care I’ve experienced here has been in Italian.

I speak to my primary care doctor in Italian. I speak to specialists in Italian. I speak to pharmacists in Italian (though one pharmacist in our village speaks excellent English for when I’m stumped). I get referrals and advice about medical care from neighbors—all in Italian.

I cannot imagine trying to navigate the system with chronic illness without speaking basic Italian—or without having someone by your side to translate and help out.

6) Ignored stories about the “poor quality” of public healthcare in Southern Italy.

One of the most often-repeated refrains about public healthcare in Italy is that it’s better in the north and not very good in the south. Well, we were moving to Southern Italy—as south as it gets in Sicily. Yes, as I recently wrote about driving here, roads in Sicily tend to have a LOT of potholes. But I chose to reserve judgment about the system until I had experienced it myself.

I am so glad I did. My experience with the public health system in Sicily has been great. Here are a few things that I’m able to easily do:

• I can call and talk to my primary care doctor five days a week (unless he’s on vacation).  

• I can walk into my primary care doctor’s office and see him the SAME DAY during office hours (four mornings and one afternoon each week). I recently had a very bad migraine that lasted a week, and my doctor was able to get me the same treatment I would have had to go to urgent care for in the US.

• If my doctor isn’t available on a specific day or time, I can go to one of the other primary care doctors in town who is open and see them.

• During evenings and weekends, we can always go to the guardia medica in town for urgent care (I’ve done it).

• When you see a primary care doctor or the guardia medica there is NO CHARGE and no billing.

• My pharmacist will help me find the cheapest option for getting medications, help me find equivalents when needed, and fill medications even if I messed up on timing and haven’t gotten the prescription yet from my primary care doctor.

• My neurologist will WhatsApp with me.

There are, of course, some things I have not yet dealt with. I have not had to go to the ER, and I haven’t needed a specialty prescription (because I no longer need them—more on that later). I have, however, had three surgeries with the national health system (also more on that later).

The Most Surprising Part of Moving to Sicily with Chronic Migraine

On the whole, moving to Italy while managing chronic migraines wasn’t easy. But all the prep work I did helped things go pretty smoothly in the end.

We moved to Sicily. I got access to primary care within about three months, and specialist care a couple of months after that. I brought enough stockpiled medications to last even longer than needed. I found equivalent meds and switched over in a careful and measured manner (one at a time). And I finished all those 100+ immigration tasks. (And yes, those immigration tasks were less stressful for me than fighting health insurance companies in the US.)

Then, something very unexpected happened.

Amidst all my intense preparation and research, I happened upon a surgeon in Genova who had published research on a cutting-edge migraine treatment (minimally invasive nerve decompression surgery). Reading more, I found this surgeon was leading a research program on the treatment with the Italian national health system.

So I added a new goal to my plan: Get a consult with this surgeon as soon as I was enrolled in the national health system. More on this in a future post!

In Closing: Chronic Illness Makes Moving Abroad Harder, But Not Impossible

This is a very long article—with a lot of logistical details! But if there’s one message I want to share, it’s that yes, it IS possible to move to Italy (or abroad more generally) even with chronic illness.

And it’s also okay to want to do it! Just because we have chronic illnesses or chronic pain doesn’t mean we have to set aside big dreams. I spent many years trying to avoid migraine triggers and boxing up dreams like living abroad. But it’s never too late to try a new approach.

During our journey to get here, people would comment about how moving to Italy and leaving our lives in New York behind was “brave.” On the inside, though, it didn’t feel brave or spontaneous or anything like what you see in movies or books or Instagram.

Our move to Sicily involved lots of lists, research, and planning—and then extra contingency planning. And all that mundane work was what made it possible.