Migraine Management: Closer Look at Diagnosis and Treatment

TOPLINE:

In England, more than half of headache cases in primary care remained unclassified, and nearly one third of patients with migraine received a preventive medication. Migraine underdiagnosis persisted, with notable gaps seen in medication use.

METHODOLOGY:

Researchers conducted a retrospective cohort study using data from the Clinical Practice Research Datalink (CPRD) Aurum to evaluate migraine diagnosis and treatment patterns in England.
The study included 1,534,807 adult patients with headache or migraine diagnoses from September 2012 to May 2023 who had continuous GP registration for at least 12 months.
Medication prescriptions were analysed for 12 months post-diagnosis to assess treatment patterns, focusing on first-line usage and overprescription on the basis of the specific criteria.
Prescription data were assessed for alignment with SIGN155/NICE CKS guidelines by using cumulative values from CPRD records.

TAKEAWAY:

Overall, 57.1% of headache cases in primary care were undifferentiated/unclassified, with migraine being the most common primary headache disorder in 78.5% of cases.
Moreover, 62.6% of patients with migraine without prior specific medication were prescribed acute treatments such as triptans and non-steroidal anti-inflammatory drugs within 12 months.
Only 36.5% of patients with migraine received a preventive medication, with tricyclic antidepressants and beta-blockers being the most common classes prescribed.
Over 40% of opioid and analgesic users were prescribed doses consistent with medication overuse. Relatively low percentages of patients reached the recommended doses for medications covered by SIGN155/NICE CKS dose guidelines.

IN PRACTICE:

“In adults, although acute medications (primarily triptans and NSAIDs [non-steroidal anti-inflammatory drugs]) largely reflect current clinical guidance, the notable prescription of opioid medications, outside of recommended guidelines, suggests opportunities for improving adherence to best practice,” the authors wrote.

SOURCE:

This study was led by David P.B. Watson, MBChB, AFOM, DRCOG, Aberdeen Royal Infirmary, Aberdeen, Scotland. It was published online on January 09, 2026, in BJGP Open.

LIMITATIONS:

The inability to determine the reason for prescriptions could have led to the overrepresentation of migraine medication use. Over-the-counter and secondary care medications were not captured in the data, potentially underrepresenting prescriptions.

DISCLOSURES:

This study was funded by Pfizer Ltd. One author reported receiving consulting fees from Pfizer Ltd. Several authors reported being employees of Pfizer Ltd or Adelphi Real World that received funding from Pfizer Ltd for the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.