Preventive treatment patterns in the adult migraine population: an observational UK study over 7 years

Abstract

Background: Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are recommended by the United Kingdom National Institute of Health and Care Excellence for the prevention of migraine as treatment beyond third line. We report migraine prevalence and preventive treatment patterns in the adult United Kingdom primary care population over a 7.5-year period, focusing on patients ceasing ≥ 3 oral preventive medication classes.

Methods: Study populations were retrieved from the Clinical Practice Research Datalink GOLD database (study period: 19 September 2012 to 1 January 2020; inclusion criteria: ≥12 months follow-up, current-in-dataset, adult on 1 January 2020). Patients who used ≥ 1 oral preventive medication with ≥ 3-year follow-up after first prescription were considered preventive treatment users; class cessation was defined as cessation without evidence of restart within 6 months from end-of-supply date.

Results: On 1 January 2020, 3.0% of the total study population were diagnosed with migraine (n = 81,190/2,664,306); of these, 42.4% were preventive treatment users (n = 34,448/81,190). The most frequently used oral migraine preventive medication classes were beta-blockers (n = 14,713), tricyclic antidepressants (n = 14,415) and antiepileptics (n = 6497). Among preventive treatment users, 7.7% (n = 2653/34,448) ceased ≥ 3 oral preventive medication classes; of these, 21.7% (n = 576/2653) had been referred to a neurologist.

Conclusions: Compared to existing population-based estimates of migraine prevalence, our data further corroborates that a considerable proportion of patients with migraine do not seek treatment. Among those who sought primary care within a 7.5-year period, almost half received empirical oral preventive treatment. Importantly, nearly 1 of 10 preventive treatment users ceased ≥ 3 oral preventive medication classes, highlighting a need for additional therapeutic options. These patients may benefit from CGRP antagonists and/or injectable onabotulinumtoxinA; however, only a minority was referred to specialist care, where these options would be more available.

Trial registration: Not applicable.

Keywords: CPRD; Calcitonin gene-related peptide antagonists; Migraine epidemiology; Migraine preventive medications.

Fig. 1

Study period and study cohorts. CPRD: Clinical Practice Research Datalink; N: number of patients in total population; NICE: National Institute for Care and Excellence

Fig. 2

Oral preventive medication class regimens by line of therapy – CPRD Migraine Preventive Treatment User Cohort (N = 34,448)^a. ^aTreatments that comprise < 1% are not displayed, so the patient count is lower than the cohort size. CPRD: Clinical Practice Research Datalink; N: number of patients in total population. Clarification: (i) In the second column, third block from the top “Anti epileptics: 2,774” is stated, and (ii) in the third column, third block from the top “Anti epileptics + Beta Blocker + Tricyclic Antidepressants: 260” is stated

Fig. 3

Oral preventive medication regimens by line of therapy – CPRD Migraine Preventive Treatment User Cohort (N = 34,448)^a. ^aTreatments that comprise < 1% are not displayed, so the patient count is lower than the cohort size. CPRD: Clinical Practice Research Datalink; N: number of patients in total population. Clarification: (i) In the second column, fourth block from the top “Topiramate: 1,159” is stated, and (ii) in the third column, second block from the top “Amitriptyline + Gabapentin + Propranolol hydrochloride: 98” is stated.