The acute migraine market is dominated by the oral triptans, although genericization of these agents as well as approvals in recent years of multiple non-oral triptans and non-triptans have begun to shift market dynamics. Triptans with unique modes of administration (e.g., injectable or patch formulations) provide options for migraineurs wishing to avoid GI effects and/or who may require a faster onset of therapeutic action; ergotamine derivatives, NSAIDs, opioid analgesics, and other non-opioid analgesics offer alternative mechanisms of action to triptans. The Migraine | Current Treatment overview provides a synopsis of current treatment goals, key therapies (including acute and prophylactic agents), and medical practice in the United States and EU5 markets for migraine. The Acute Migraine | Current Treatment | US detailed, expanded analysis explores how U.S. neurologists and general practitioners/primary care physicians are currently treating their migraine patients, with a particular focus on use of acute therapies, as well as insight into the factors driving such prescribing habits.

Table of contents

  • Migraine - Current Treatment - Detailed, Expanded Analysis (US): Acute Treatments
    • Physician Prescribing Practices
      • Key Findings
      • Patient Characteristics
        • More Than Half of Migraine Patients Have EM and the Majority Have Insurance
        • Episodic vs. Chronic Migraine Patients Among Neurologists and GPs/PCPs (Survey Data)
        • Insurance Status Among Migraineurs for Neurologists and GPs/PCPs (Survey Data)
        • Gender Distribution Among Patients Diagnosed with Migraine (RWD: EHR)
        • Race Distribution Among Patients Diagnosed with Migraine (RWD: EHR)
        • Age Distribution Among Patients Diagnosed with Migraine (RWD: EHR)
        • Body Mass Index Distribution Among Patients Diagnosed with Migraine (RWD: EHR)
      • Treatment Practices
        • Generic Oral Triptan Dominance in Early Lines Relegates Brands to Late Lines
        • Neurologists Use a Wider Non-Oral Armamentarium than PCPs in Acute Treatment of Migraineurs (Survey Data)
        • Time to Treatment Start in Episodic Migraineurs Is Similar Between Physician Types
        • Time Between Diagnosis and Treatment in Episodic and Chronic Migraineurs (Survey Data)
        • Approximately Half of Diagnosed Patients Receive Prescription Acute Treatment
        • Prescription Therapy Acute Treatment Rates for Episodic and Chronic Migraineurs (Survey Data)
        • Treatment Rate for Patients Diagnosed with Migraine (RWD: EHR)
        • Treatment Rates for Mini-Prophylaxis (Survey Data)
        • Neurologists' and PCPs' Prescribing Patterns Show Overarching Similarities
        • Patient Share by Product Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Quarter-Over-Quarter Patient Share by Product Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Current Acute Treatment Rates by Drug Class (Survey Data)
        • Current Oral Triptan Drug-Treatment Rates (Survey Data)
        • Current Acute Non-Oral Triptan Treatment Rates (Survey Data)
        • Current Acute Treatment Rates for Prescription NSAIDs/Opioids/Analgesics (Survey Data)
        • Current Acute Treatment Rates for Prescription Mini-Prophylaxis (Survey Data)
        • No One Prescription Antimigraine Agent Has Longer Treatment Duration Than Others
        • Average Months of Acute Treatment for Episodic Migraineurs: Oral Triptans (Survey Data)
        • Average Months of Acute Treatment for Episodic Migraineurs: Non-Oral Triptans and Ergot Derivatives (Survey Data)
        • Average Months of Acute Treatment for Episodic Migraineurs: Other Analgesics (Survey Data)
        • Average Months of Acute Treatment for Chronic Migraineurs: Oral Triptans (Survey Data)
        • Average Months of Acute Treatment for Chronic Migraineurs: Non-Oral Triptans and Ergot Derivatives (Survey Data)
        • Average Months of Acute Treatment for Chronic Migraineurs: Other Analgesics (Survey Data)
        • Treatment Duration by Product Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Physicians Rely on Lifestyle Changes and OTC Agents to Treat Migraine
        • Percentage of Physicians Who Recommend Select Nonpharmacological Approaches (Survey Data)
        • Triptans Dominate Early Lines of the Migraine Treatment Algorithm
        • A High Percentage of Newly Diagnosed Migraineurs Remain on First-Line Treatment
        • Percentage of Drug-Treated Migraineurs on First Three Lines of Prescription Acute Treatment (Survey Data)
        • Source of Business by Product Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Progression Rates Between Lines Are Higher for Chronic Migraineurs
        • Percentage of Migraineurs Progressing Between Lines of Therapy by Migraine Type and Specialty (Survey Data)
        • Time to Progression Between Lines of Therapy by Migraine Type (Survey Data)
        • First Lines of Therapy Remain Entrenched in the Migraine Treatment Algorithm
        • PCPs' Product Patient Share by Line of Therapy for Acute Treatment of Migraine (Survey Data)
        • Neurologists' Product Patient Share by Line of Therapy for Acute Treatment of Migraine (Survey Data)
        • Product Patient Share by Line of Therapy Among Drug-Treated Patients Newly Diagnosed with Migraine (RWD: Claims)
        • Quarter-Over-Quarter Product Patient Share by First Line of Therapy Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • First-Line Length of Treatment Is Longer Than in Later Lines
        • Progression Rates from First Line of Therapy Among Drug-Treated Patients Newly Diagnosed with Migraine (RWD: Claims)
        • Progression Rates from Second Line of Therapy Among Drug-Treated Patients Newly Diagnosed with Migraine (RWD: Claims)
        • Combination Therapy Is Uncommon in Acute Treatment of Migraine
        • Percentage of Drug-Treated Migraine Patients Receiving More Than One Prescription Treatment for Migraine (Survey Data)
        • Most Common Acute Antimigraine Therapies Prescribed in Combination by PCPs (Survey Data)
        • Most Common Acute Antimigraine Therapies Prescribed in Combination by Neurologists (Survey Data)
        • Drug Burden Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Drug Burden by Line of Therapy Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Monotherapy vs. Combination Therapy Use by First-Line Therapy Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Monotherapy vs. Combination Therapy Use by Third-Line Therapy Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Top Combinations of Therapies in the First Line Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Top Combinations of Therapies in the Third Line Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
      • Persistency and Compliance
        • Compliance and Persistency Rates Are Generally Consistent Among Oral Triptans
        • Rates of Discontinuation Among Patients by Migraine Type: PCPs (Survey Data)
        • Rates of Discontinuation Among Patients by Migraine Type: Neurologists (Survey Data)
        • Patient Compliance Rates by Migraine Type: PCPs (Survey Data)
        • Patient Compliance Rates by Migraine Type: Neurologists (Survey Data)
        • Compliance by Brand Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Persistency by Brand Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Persistency Sample Sizes Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Ranges of Medication Possession Ratios Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
      • Sequencing of Treatment
        • Use of Branded Antimigraine Agents in Later Lines of Therapy
        • Source of Migraineurs Who Have Initiated Branded Antimigraine Therapies by Specialty (Survey Data)
        • Treatment Flow of Migraineurs Who Discontinued Branded Antimigraine Therapy by Specialty (Survey Data)
        • Comparison of Progression Patterns and Key Therapy Sources Among Migraine Patients (RWD: Claims)
        • Sumatriptan (Oral) Patient Flow in Newly Diagnosed Migraine Patients (RWD: Claims)
        • Sumatriptan (Oral) Patient Flow in Recently Treated Migraine Patients (RWD: Claims)
        • Rizatriptan Patient Flow in Newly Diagnosed Migraine Patients (RWD: Claims)
        • Rizatriptan Patient Flow in Recently Treated Migraine Patients (RWD: Claims)
        • Relpax Patient Flow in Newly Diagnosed Migraine Patients (RWD: Claims)
        • Relpax Patient Flow in Recently Treated Migraine Patients (RWD: Claims)
        • Sumatriptan (Nasal Spray) Patient Flow in Newly Diagnosed Migraine Patients (RWD: Claims)
        • Sumatriptan (Nasal Spray) Patient Flow in Recently Treated Migraine Patients (RWD: Claims)
        • Sumatriptan (Standard SC Injectable) Patient Flow in Newly Diagnosed Migraine Patients (RWD: Claims)
        • Sumatriptan (Standard SC Injectable) Patient Flow in Recently Treated Migraine Patients (RWD: Claims)
        • Treximet Patient Flow in Newly Diagnosed Migraine Patients (RWD: Claims)
        • Treximet Patient Flow in Recently Treated Migraine Patients (RWD: Claims)
        • Zecuity Patient Flow in Newly Diagnosed Migraine Patients (RWD: Claims)
        • Zecuity Patient Flow in Recently Treated Migraine Patients (RWD: Claims)
        • Dihydroergotamine (Nasal Spray) Patient Flow in Newly Diagnosed Migraine Patients (RWD: Claims)
        • Dihydroergotamine (Nasal Spray) Patient Flow in Recently Treated Migraine Patients (RWD: Claims)
        • Cambia Patient Flow in Newly Diagnosed Migraine Patients (RWD: Claims)
        • Cambia Patient Flow in Recently Treated Migraine Patients (RWD: Claims)
      • Recent/Anticipated Changes in Brand Usage/Treatment Approach
        • Remarkably Stable Patterns in Acute Migraine Treatment Are Unlikely to Change
        • Anticipated Changes in the Use of Antimigraine Drug Classes by Physician Specialty (Survey Data)
        • Anticipated Acute Treatment Use of Oral Triptans: Episodic Migraineurs (Survey Data)
        • Anticipated Acute Treatment Use of Oral Triptans: Chronic Migraineurs (Survey Data)
        • Anticipated Acute Treatment Use of Non-Oral Triptans: Episodic Migraineurs (Survey Data)
        • Anticipated Acute Treatment Use of Non-Oral Triptans: Chronic Migraineurs (Survey Data)
    • Physician Insight on Medical Practice
      • Key Findings
      • Drivers of Treatment Selection
        • Access and Cost Concerns Influence Migraine Treatment
        • A Variety of Clinical and Non-Clinical Factors Influence Migraine Treatment
        • Ranking of Top Three Factors Influencing Acute Migraine Treatment with Oral Triptans (Survey Data)
        • Ranking of Top Three Factors Influencing Acute Migraine Treatment with Non-Oral Triptans (Survey Data)
        • Ranking of Top Three Factors Influencing Acute Migraine Treatment with Oral Ergot Derivatives (Survey Data)
        • Ranking of Top Three Factors Influencing Acute Migraine Treatment with Non-Oral Ergot Derivatives (Survey Data)
        • Ranking of Top Three Factors Influencing Acute Migraine Treatment with NSAIDs/Opioids/Analgesics (Survey Data)
        • Zecuity Differentiation Stems from Novel Delivery
        • Most Influential Factors Driving Prescribing of Zecuity for Acute Migraine (Survey Data)
        • Increased Zecuity Prescription Is Often Constrained by Cost/Payer Pressures
        • Main Obstacles to Increased Use of Zecuity for Acute Migraine (Zecuity Prescribers) (Survey Data)
        • Main Obstacles to Increased Use of Zecuity for Acute Migraine (Zecuity Nonprescribers) (Survey Data)
        • A Diverse Set of Factors Drives Switching Between Acute Migraine Treatments
        • Primary Reasons for Switching to Acute Migraine Treatments (Neurologists) (Survey Data)
        • Primary Reasons for Switching to Acute Migraine Treatments (GPs/PCPs) (Survey Data)
        • Reasons for Discontinuation Generally Correlate with Formulation and Generic Availability
        • Reasons for Switching OFF Therapies in Acute Migraineurs Reported by Neurologists (Survey Data)
        • Reasons for Switching OFF Therapies in Acute Migraineurs Reported by GPs/PCPs (Survey Data)
        • Physicians Show Lack of Consensus on Reasons for Not Treating More Patients
        • Reasons Why More Migraine Patients Do Not Receive Prescription Acute Therapy (Survey Data)
      • Face-to-Face Product Detailing Effectiveness
        • Further Opportunity Exists for Brand Differentiation During Detailing Visits
        • Neurologists, GPs, and PCPs Experience Similar Detailing Frequency
        • Restriction of Sales Representative Access (Survey Data)
        • Overall Rate of Physician Detailing Within the Past Year
        • Frequency of Sales Representatives' Visits for Selected Brands in the Past Year (Survey Data)
        • Reach of Sales Representatives for Selected Brands (Survey Data)
        • Physicians Report High Satisfaction with Product Sales Representatives
        • Recently Detailed Physicians' Satisfaction with Selected Brand Sales Representatives' Knowledge of Migraine (Survey Data)
        • Recently Detailed Physicians' Satisfaction with Selected Brand Sales Representatives' Knowledge of the Agent (Survey Data)
        • Recently Detailed Physicians' Satisfaction with Selected Brand Sales Representatives' Ability to Address Logistical Questions (Survey Data)
        • Physicians Recall Many Messages from Detailing Visits
        • Aided Message Recall Among Recently Detailed Physicians (Survey Data)
    • Methodology
      • Primary Market Research Methodology
      • Percentages of Board-Certified Practicing Physicians (Survey Data)
      • Years in Practice Postresidency Among Neurologists and GPs/PCPs (Survey Data)
      • Mean Years in Practice Postresidency Among Neurologists and GPs/PCPs(Survey Data)
      • Migraineurs Treated per Month by Surveyed Neurologists and GPs/PCPs (Survey Data)
      • Mean Migraineurs Treated per Month by Surveyed Neurologists and GPs/PCPs (Survey Data)
      • Regional Distribution of Surveyed Neurologists and GPs/PCPs (Survey Data)
      • State-Wise Distribution of Surveyed Neurologists and GPs/PCPs (Survey Data)
      • Practice Types Among Surveyed Neurologists and GPs/PCPs (Survey Data)
      • RWD Methodology
      • Limitations of Comparative Analyses Between Data Sources
    • Appendix
      • Primary Market Research
        • Recently Detailed Physicians' Satisfaction with Selected Brand Sales Representatives' Knowledge of Migraine by Specialty (Survey Data)
        • Recently Detailed Physicians' Satisfaction with Selected Brand Sales Representatives' Knowledge of the Agent by Specialty (Survey Data)
        • Recently Detailed Physicians' Satisfaction with Selected Brand Sales Representatives' Ability to Address Logistical Questions by Specialty (Survey Data)
        • Aided Message Recall Among Recently Detailed Physicians by Specialty (Survey Data)
      • Claims Data
        • Quarter-Over-Quarter Product Patient Share by Second Line of Therapy Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Quarter-Over-Quarter Product Patient Share by Third Line of Therapy Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Monotherapy vs. Combination Therapy Use by Second Line of Therapy Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Combination Therapies by Second Line of Therapy Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)

Author(s): Andrea Witt, PhD

Andrea S. Witt, Ph.D., is Therapy Leader of the Central Nervous System and Ophthalmology Disorders Portfolio at Decision Resources Group where she oversees a team of 14 Business Insights Analysts and Senior Directors responsible for market research encompassing Neurology, Psychiatry, Pain, and Ophthalmology.

 Dr. Witt has been with Decision Resources Group for over 12 years, following CNS markets and trends. Her interests beyond specific CNS indications included the market potential for neuroprotectants and the impact of biomarkers on CNS markets. Dr. Witt’s research, analysis, and commentaries have appeared in Barron’s, Pharmaceutical Executive, PharmaVoice, Nature Medicine, and CNBC. Dr. Witt’s previous experience includes 10 years of scientific research conducted on neurodegenerative disorders at Harvard Medical School/Brigham and Women’s Hospital, Duke University, and the University of Texas-Southwestern Medical Center, where she earned her Ph.D. degree.


Related Reports

Migraine - Landscape & Forecast - Disease Landscape & Forecast

The market for prescription migraine therapies comprises an array of

View Details

Migraine | Disease Landscape and Forecast | G7 | 2020

The market for prescription migraine therapies comprises an array of acute and prophylactic treatments and fosters a large and dynamic pipeline. In the acute space, we anticipate the launch of seve...

View Details

Migraine - Geographic Focus: China - Migraine - China In-Depth (China)

Migraine presents a major public health burden in China, leading to impaired quality of life, widespread health loss, and loss of productivity for a sizeable population. Owing to migraine’s n...

View Details

Migraine - Current Treatment - Detailed, Expanded Analysis (EU5)

According to DRG epidemiology, over 30 million people in the EU5 suffer migraines and over 10% of migraineurs suffer chronic migraine. Migraine prophylaxis is a core treatment approach for high-fre...

View Details