Migraine Prophylaxis | Current Treatment | Physician Insights | US

According to DRG epidemiology, more than 35 million people in the United States suffer migraines, and more than 10% of migraineurs suffer from chronic migraine (CM). Migraine prophylaxis is a core, but underused, treatment approach to reduce migraine frequency, severity, and duration in high-frequency episodic migraine and CM patients. Treatment options are primarily a mix of off-label and approved AEDs, beta blockers, and TCAs, as well as Botox (Allergan’s onabotulinumtoxinA), one of the few agents approved specifically for CM. However, given the heterogeneous patient population, chronic prophylactic treatment is individualized and can evolve over time. Understanding patient pathways and drivers of treatment decision-making is key for new players entering this large but mostly generic market.


  • What factors do U.S. physicians look for when determining if a patient is fit for prophylactic treatment?
  • What are the drivers and constraints influencing physicians’ treatment decisions for migraine prophylaxis?
  • How long does it take for patients to progress between lines of therapy? How are patients being treated across different lines of therapy?
  • To what extent is polypharmacy prescribed for prophylaxis, and what are physicians’ preferred drug class combinations?
  • How has the use of key prophylactic therapies changed in the past year, and what changes do physicians expect in their prescribing of these drugs in one year?
  • How do Botox (Allergan) and Trokendi XR (Supernus) compete in the generics-heavy migraine market? What drivers and constraints will aid or restrict their future use?


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