According to DRG epidemiology, more than 35 million people in the United States suffer migraines, and more than 10% of migraineurs suffer from chronic migraine (CM). Migraine prophylaxis is a core, but underused, treatment approach to reduce migraine frequency, severity, and duration in high-frequency episodic migraine and CM patients. Treatment options are primarily a mix of off-label and approved AEDs, beta blockers, and TCAs, as well as Botox (Allergan’s onabotulinumtoxinA), one of the few agents approved specifically for CM. However, given the heterogeneous patient population, chronic prophylactic treatment is individualized and can evolve over time. Understanding patient pathways and drivers of treatment decision-making is key for new players entering this large but mostly generic market.


  • What factors do U.S. physicians look for when determining if a patient is fit for prophylactic treatment?
  • What are the drivers and constraints influencing physicians’ treatment decisions for migraine prophylaxis?
  • How long does it take for patients to progress between lines of therapy? How are patients being treated across different lines of therapy?
  • To what extent is polypharmacy prescribed for prophylaxis, and what are physicians’ preferred drug class combinations?
  • How has the use of key prophylactic therapies changed in the past year, and what changes do physicians expect in their prescribing of these drugs in one year?
  • How do Botox (Allergan) and Trokendi XR (Supernus) compete in the generics-heavy migraine market? What drivers and constraints will aid or restrict their future use?


Current Treatment:

Provides physician insights on prescribing behavior, treatment paths, and the factors and perceptions driving brand use so that you can understand each brand’s performance and improve or defend your competitive position.

Table of contents

  • Migraine - Current Treatment - Detailed, Expanded Analysis (US) : Migraine Prophylaxis

Author(s): Audreza Das, P.G. Dip. ; Jonathan Searles

Audreza Das is a Senior Analyst in the CNS/Ophthalmology team at Decision Resources Group

She has authored content across indications, including neuropathic pain, age-related macular degeneration, treatment-related depression, painful diabetic neuropathy, and migraine. Ms. Das has previously worked at Novo Nordisk, as a Market Analyst for European markets. Previous experience at a SME, included developing disease competitive landscapes, covering global conferences etc. Ms. Das received her B.E. degree in Biotechnology from Birla Institute of Technology, a deemed university and her P.G. Diploma in Cancer Immunology & Biotechnology from University of Nottingham.

Jonathan W. Searles is a Senior Director in the CNS/Ophthalmology unit at DRG, overseeing the neurology research stream. Prior to joining DRG, Mr. Searles received a B.A. degree, summa cum laude, from Brandeis University; during this time, Mr. Searles conducted research projects at the Harvard University Peabody Museum and at Brandeis.

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