Migraine management in France: Practices of general practitioners and neurologists

Abstract

Background: In 2024, despite updated French guidelines, migraine remains underdiagnosed and undertreated. We conducted a comprehensive survey to evaluate the management of migraine patients by French general practitioners (GPs) and neurologists, and to identify factors linked to low prescription rates of recommended treatments.

Methods: A total of 320 GPs and 215 neurologists practicing in France were analyzed after completing an online questionnaire (between June and October 2023) regarding their prescribing behaviors and influencing factors, whose potential associations were analyzed statistically.

Results: GPs most commonly prescribe triptans (71.6%) and non-steroidal anti-inflammatory drugs (NSAIDs, 66.6%) for acute migraine treatment, and propranolol (71.6%) as prophylaxis. Lower prescribing rates were associated with shorter practice duration, negative perceptions of risk-benefit and lack of recent migraine training. Conversely, recent migraine training significantly reduced low prescription rates of prophylactic treatments. Neurologists frequently prescribe triptans (93.5%) and NSAIDs (89.3%) for acute treatment, as well as propranolol (76.3%) and amitriptyline (61.4%) as prophylaxis. The prescription of newer treatments like calcitonin gene-related peptide monoclonal antibodies is limited, with only 7.0% of respondents frequently using them.

Conclusion: While GPs and neurologists often use recommended acute treatments, prophylactic and newer therapies are less commonly prescribed, despite recently updated French guidelines on migraine management.

Keywords: Healthcare surveys; Migraine treatment; Opioids; Prescription practices; Triptans.