Patterns of initial migraine treatment in Denmark: A population-based study

Area of Science:

• Neurology
• Public Health
• Pharmacology

Background:

• Migraine affects a significant portion of the adult population, with established acute and prophylactic treatment options.
• Data on the initial treatment patterns for newly diagnosed migraine patients are limited, especially regarding the utilization of prophylactic versus acute therapies.
• Understanding initial treatment choices is crucial for optimizing migraine management strategies.

Purpose of the Study:

• To investigate the initial treatment patterns for newly diagnosed migraine patients in Denmark.
• To identify patient characteristics associated with the use of prophylactic versus acute migraine therapies.
• To describe the utilization of different treatment strategies in a real-world, population-based setting.

Main Methods:

• A nationwide cohort of adult migraine patients diagnosed between 2005 and 2013 was assembled using Danish health databases.
• Migraine diagnosis was established through hospital records or prescription data for specific migraine medications (triptans, ergots, pizotifen, flunarizine).
• Initial treatment was categorized as 'no treatment,' 'acute only,' 'prophylactic only,' or 'both acute and prophylactic,' with analysis of patient demographics, comorbidities, and comedications.

Main Results:

• The study included 97,431 migraine patients, with 88.2% receiving "acute only" treatment initially.
• Prophylactic treatment (alone or with acute) was initiated by only 7.1% of patients and was more common in older patients with comorbidities like hypertension and diabetes.
• Nonpersistence with initial prophylactic treatment was high, with 35% discontinuing therapy within the first year.

Conclusions:

• The vast majority of incident migraine patients (88%) were initially treated with acute medications only.
• The use of prophylactic migraine medication as an initial treatment strategy was low.
• Initiation of prophylactic treatment was associated with older age and the presence of comorbidities, suggesting undertreatment in younger or less comorbid populations.