Migraine – Current Treatment – Detailed, Expanded Analysis (US): Acute Treatments

The acute migraine market is dominated by the oral triptans, although genericization of these agents as well as approvals in recent years of multiple non-oral triptans and non-triptans have begun to shift market dynamics. Triptans with unique modes of administration (e.g., injectable or patch formulations) provide options for migraineurs wishing to avoid GI effects and/or who may require a faster onset of therapeutic action; ergotamine derivatives, NSAIDs, opioid analgesics, and other non-opioid analgesics offer alternative mechanisms of action to triptans. The Migraine | Current Treatment overview provides a synopsis of current treatment goals, key therapies (including acute and prophylactic agents), and medical practice in the United States and EU5 markets for migraine. The Acute Migraine | Current Treatment | US detailed, expanded analysis explores how U.S. neurologists and general practitioners/primary care physicians are currently treating their migraine patients, with a particular focus on use of acute therapies, as well as insight into the factors driving such prescribing habits.

Table of contents

  • Migraine - Current Treatment - Detailed, Expanded Analysis (US): Acute Treatments
    • Physician Prescribing Practices
      • Key Findings
      • Patient Characteristics
        • More Than Half of Migraine Patients Have EM and the Majority Have Insurance
        • Episodic vs. Chronic Migraine Patients Among Neurologists and GPs/PCPs (Survey Data)
        • Insurance Status Among Migraineurs for Neurologists and GPs/PCPs (Survey Data)
        • Gender Distribution Among Patients Diagnosed with Migraine (RWD: EHR)
        • Race Distribution Among Patients Diagnosed with Migraine (RWD: EHR)
        • Age Distribution Among Patients Diagnosed with Migraine (RWD: EHR)
        • Body Mass Index Distribution Among Patients Diagnosed with Migraine (RWD: EHR)
      • Treatment Practices
        • Generic Oral Triptan Dominance in Early Lines Relegates Brands to Late Lines
        • Neurologists Use a Wider Non-Oral Armamentarium than PCPs in Acute Treatment of Migraineurs (Survey Data)
        • Time to Treatment Start in Episodic Migraineurs Is Similar Between Physician Types
        • Time Between Diagnosis and Treatment in Episodic and Chronic Migraineurs (Survey Data)
        • Approximately Half of Diagnosed Patients Receive Prescription Acute Treatment
        • Prescription Therapy Acute Treatment Rates for Episodic and Chronic Migraineurs (Survey Data)
        • Treatment Rate for Patients Diagnosed with Migraine (RWD: EHR)
        • Treatment Rates for Mini-Prophylaxis (Survey Data)
        • Neurologists' and PCPs' Prescribing Patterns Show Overarching Similarities
        • Patient Share by Product Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Quarter-Over-Quarter Patient Share by Product Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Current Acute Treatment Rates by Drug Class (Survey Data)
        • Current Oral Triptan Drug-Treatment Rates (Survey Data)
        • Current Acute Non-Oral Triptan Treatment Rates (Survey Data)
        • Current Acute Treatment Rates for Prescription NSAIDs/Opioids/Analgesics (Survey Data)
        • Current Acute Treatment Rates for Prescription Mini-Prophylaxis (Survey Data)
        • No One Prescription Antimigraine Agent Has Longer Treatment Duration Than Others
        • Average Months of Acute Treatment for Episodic Migraineurs: Oral Triptans (Survey Data)
        • Average Months of Acute Treatment for Episodic Migraineurs: Non-Oral Triptans and Ergot Derivatives (Survey Data)
        • Average Months of Acute Treatment for Episodic Migraineurs: Other Analgesics (Survey Data)
        • Average Months of Acute Treatment for Chronic Migraineurs: Oral Triptans (Survey Data)
        • Average Months of Acute Treatment for Chronic Migraineurs: Non-Oral Triptans and Ergot Derivatives (Survey Data)
        • Average Months of Acute Treatment for Chronic Migraineurs: Other Analgesics (Survey Data)
        • Treatment Duration by Product Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Physicians Rely on Lifestyle Changes and OTC Agents to Treat Migraine
        • Percentage of Physicians Who Recommend Select Nonpharmacological Approaches (Survey Data)
        • Triptans Dominate Early Lines of the Migraine Treatment Algorithm
        • A High Percentage of Newly Diagnosed Migraineurs Remain on First-Line Treatment
        • Percentage of Drug-Treated Migraineurs on First Three Lines of Prescription Acute Treatment (Survey Data)
        • Source of Business by Product Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Progression Rates Between Lines Are Higher for Chronic Migraineurs
        • Percentage of Migraineurs Progressing Between Lines of Therapy by Migraine Type and Specialty (Survey Data)
        • Time to Progression Between Lines of Therapy by Migraine Type (Survey Data)
        • First Lines of Therapy Remain Entrenched in the Migraine Treatment Algorithm
        • PCPs' Product Patient Share by Line of Therapy for Acute Treatment of Migraine (Survey Data)
        • Neurologists' Product Patient Share by Line of Therapy for Acute Treatment of Migraine (Survey Data)
        • Product Patient Share by Line of Therapy Among Drug-Treated Patients Newly Diagnosed with Migraine (RWD: Claims)
        • Quarter-Over-Quarter Product Patient Share by First Line of Therapy Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • First-Line Length of Treatment Is Longer Than in Later Lines
        • Progression Rates from First Line of Therapy Among Drug-Treated Patients Newly Diagnosed with Migraine (RWD: Claims)
        • Progression Rates from Second Line of Therapy Among Drug-Treated Patients Newly Diagnosed with Migraine (RWD: Claims)
        • Combination Therapy Is Uncommon in Acute Treatment of Migraine
        • Percentage of Drug-Treated Migraine Patients Receiving More Than One Prescription Treatment for Migraine (Survey Data)
        • Most Common Acute Antimigraine Therapies Prescribed in Combination by PCPs (Survey Data)
        • Most Common Acute Antimigraine Therapies Prescribed in Combination by Neurologists (Survey Data)
        • Drug Burden Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Drug Burden by Line of Therapy Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Monotherapy vs. Combination Therapy Use by First-Line Therapy Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Monotherapy vs. Combination Therapy Use by Third-Line Therapy Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Top Combinations of Therapies in the First Line Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Top Combinations of Therapies in the Third Line Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
      • Persistency and Compliance
        • Compliance and Persistency Rates Are Generally Consistent Among Oral Triptans
        • Rates of Discontinuation Among Patients by Migraine Type: PCPs (Survey Data)
        • Rates of Discontinuation Among Patients by Migraine Type: Neurologists (Survey Data)
        • Patient Compliance Rates by Migraine Type: PCPs (Survey Data)
        • Patient Compliance Rates by Migraine Type: Neurologists (Survey Data)
        • Compliance by Brand Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Persistency by Brand Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Persistency Sample Sizes Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Ranges of Medication Possession Ratios Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
      • Sequencing of Treatment
        • Use of Branded Antimigraine Agents in Later Lines of Therapy
        • Source of Migraineurs Who Have Initiated Branded Antimigraine Therapies by Specialty (Survey Data)
        • Treatment Flow of Migraineurs Who Discontinued Branded Antimigraine Therapy by Specialty (Survey Data)
        • Comparison of Progression Patterns and Key Therapy Sources Among Migraine Patients (RWD: Claims)
        • Sumatriptan (Oral) Patient Flow in Newly Diagnosed Migraine Patients (RWD: Claims)
        • Sumatriptan (Oral) Patient Flow in Recently Treated Migraine Patients (RWD: Claims)
        • Rizatriptan Patient Flow in Newly Diagnosed Migraine Patients (RWD: Claims)
        • Rizatriptan Patient Flow in Recently Treated Migraine Patients (RWD: Claims)
        • Relpax Patient Flow in Newly Diagnosed Migraine Patients (RWD: Claims)
        • Relpax Patient Flow in Recently Treated Migraine Patients (RWD: Claims)
        • Sumatriptan (Nasal Spray) Patient Flow in Newly Diagnosed Migraine Patients (RWD: Claims)
        • Sumatriptan (Nasal Spray) Patient Flow in Recently Treated Migraine Patients (RWD: Claims)
        • Sumatriptan (Standard SC Injectable) Patient Flow in Newly Diagnosed Migraine Patients (RWD: Claims)
        • Sumatriptan (Standard SC Injectable) Patient Flow in Recently Treated Migraine Patients (RWD: Claims)
        • Treximet Patient Flow in Newly Diagnosed Migraine Patients (RWD: Claims)
        • Treximet Patient Flow in Recently Treated Migraine Patients (RWD: Claims)
        • Zecuity Patient Flow in Newly Diagnosed Migraine Patients (RWD: Claims)
        • Zecuity Patient Flow in Recently Treated Migraine Patients (RWD: Claims)
        • Dihydroergotamine (Nasal Spray) Patient Flow in Newly Diagnosed Migraine Patients (RWD: Claims)
        • Dihydroergotamine (Nasal Spray) Patient Flow in Recently Treated Migraine Patients (RWD: Claims)
        • Cambia Patient Flow in Newly Diagnosed Migraine Patients (RWD: Claims)
        • Cambia Patient Flow in Recently Treated Migraine Patients (RWD: Claims)
      • Recent/Anticipated Changes in Brand Usage/Treatment Approach
        • Remarkably Stable Patterns in Acute Migraine Treatment Are Unlikely to Change
        • Anticipated Changes in the Use of Antimigraine Drug Classes by Physician Specialty (Survey Data)
        • Anticipated Acute Treatment Use of Oral Triptans: Episodic Migraineurs (Survey Data)
        • Anticipated Acute Treatment Use of Oral Triptans: Chronic Migraineurs (Survey Data)
        • Anticipated Acute Treatment Use of Non-Oral Triptans: Episodic Migraineurs (Survey Data)
        • Anticipated Acute Treatment Use of Non-Oral Triptans: Chronic Migraineurs (Survey Data)
    • Physician Insight on Medical Practice
      • Key Findings
      • Drivers of Treatment Selection
        • Access and Cost Concerns Influence Migraine Treatment
        • A Variety of Clinical and Non-Clinical Factors Influence Migraine Treatment
        • Ranking of Top Three Factors Influencing Acute Migraine Treatment with Oral Triptans (Survey Data)
        • Ranking of Top Three Factors Influencing Acute Migraine Treatment with Non-Oral Triptans (Survey Data)
        • Ranking of Top Three Factors Influencing Acute Migraine Treatment with Oral Ergot Derivatives (Survey Data)
        • Ranking of Top Three Factors Influencing Acute Migraine Treatment with Non-Oral Ergot Derivatives (Survey Data)
        • Ranking of Top Three Factors Influencing Acute Migraine Treatment with NSAIDs/Opioids/Analgesics (Survey Data)
        • Zecuity Differentiation Stems from Novel Delivery
        • Most Influential Factors Driving Prescribing of Zecuity for Acute Migraine (Survey Data)
        • Increased Zecuity Prescription Is Often Constrained by Cost/Payer Pressures
        • Main Obstacles to Increased Use of Zecuity for Acute Migraine (Zecuity Prescribers) (Survey Data)
        • Main Obstacles to Increased Use of Zecuity for Acute Migraine (Zecuity Nonprescribers) (Survey Data)
        • A Diverse Set of Factors Drives Switching Between Acute Migraine Treatments
        • Primary Reasons for Switching to Acute Migraine Treatments (Neurologists) (Survey Data)
        • Primary Reasons for Switching to Acute Migraine Treatments (GPs/PCPs) (Survey Data)
        • Reasons for Discontinuation Generally Correlate with Formulation and Generic Availability
        • Reasons for Switching OFF Therapies in Acute Migraineurs Reported by Neurologists (Survey Data)
        • Reasons for Switching OFF Therapies in Acute Migraineurs Reported by GPs/PCPs (Survey Data)
        • Physicians Show Lack of Consensus on Reasons for Not Treating More Patients
        • Reasons Why More Migraine Patients Do Not Receive Prescription Acute Therapy (Survey Data)
      • Face-to-Face Product Detailing Effectiveness
        • Further Opportunity Exists for Brand Differentiation During Detailing Visits
        • Neurologists, GPs, and PCPs Experience Similar Detailing Frequency
        • Restriction of Sales Representative Access (Survey Data)
        • Overall Rate of Physician Detailing Within the Past Year
        • Frequency of Sales Representatives' Visits for Selected Brands in the Past Year (Survey Data)
        • Reach of Sales Representatives for Selected Brands (Survey Data)
        • Physicians Report High Satisfaction with Product Sales Representatives
        • Recently Detailed Physicians' Satisfaction with Selected Brand Sales Representatives' Knowledge of Migraine (Survey Data)
        • Recently Detailed Physicians' Satisfaction with Selected Brand Sales Representatives' Knowledge of the Agent (Survey Data)
        • Recently Detailed Physicians' Satisfaction with Selected Brand Sales Representatives' Ability to Address Logistical Questions (Survey Data)
        • Physicians Recall Many Messages from Detailing Visits
        • Aided Message Recall Among Recently Detailed Physicians (Survey Data)
    • Appendix
      • Primary Market Research
        • Recently Detailed Physicians' Satisfaction with Selected Brand Sales Representatives' Knowledge of Migraine by Specialty (Survey Data)
        • Recently Detailed Physicians' Satisfaction with Selected Brand Sales Representatives' Knowledge of the Agent by Specialty (Survey Data)
        • Recently Detailed Physicians' Satisfaction with Selected Brand Sales Representatives' Ability to Address Logistical Questions by Specialty (Survey Data)
        • Aided Message Recall Among Recently Detailed Physicians by Specialty (Survey Data)
      • Claims Data
        • Quarter-Over-Quarter Product Patient Share by Second Line of Therapy Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Quarter-Over-Quarter Product Patient Share by Third Line of Therapy Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Monotherapy vs. Combination Therapy Use by Second Line of Therapy Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)
        • Combination Therapies by Second Line of Therapy Among Drug-Treated Patients Diagnosed with Migraine (RWD: Claims)