Up to 85% of migraine patients preferred an oral daily CGRP antagonist pill over injectable CGRP monoclonal antibodies, with route of administration being the most valued attribute after side effect profile.
7 in 10 patientspreferred an oral daily CGRP antagonist pill over injectable CGRP monoclonal antibodies, even with comparable efficacy
What the researchers found
In a discrete-choice experiment, 70-85% of episodic migraine patients preferred an oral daily pill profile (like the CGRP receptor antagonist atogepant) over injectable CGRP monoclonal antibody profiles, even when efficacy was similar. The two most important treatment attributes were: (1) absence of nausea and (2) oral pill administration rather than injection or infusion. Patients valued oral delivery approximately 2.5 times more than avoiding mild nausea.
Why it matters
CGRP-targeting therapies have transformed migraine prevention, but patients now have both oral peptide receptor antagonists (gepants) and injectable monoclonal antibodies to choose from. Understanding patient preferences helps clinicians align treatment choices with patient values, potentially improving adherence and outcomes.
The numbers in context
70.9-85.4% preferred oral atogepant-like profile vs injectable mAbs · 70.7-73.8% vs composite mAb class · oral > injection valued ~2.5x more than avoiding mild nausea · 7 attributes tested
How the study worked
Discrete-choice experiment survey administered to US adults (aged 18-80) with episodic migraine who were CGRP therapy-naïve, between November-December 2020. Respondents compared pairs of hypothetical treatment profiles defined by 7 attributes with varying levels. Preference weights estimated conditional relative importance and predicted probability of preferring different treatment profiles.
Who was studied
US adults with episodic migraine, naive to CGRP-targeting therapies
What this study cannot tell us
Survey-based stated preferences may not perfectly predict real-world treatment choices. Respondents were CGRP therapy-naïve, so preferences reflect expectations rather than experience. The study was conducted in 2020 when some CGRP therapies were relatively new. Funded by AbbVie (atogepant manufacturer), which may introduce bias in study design and framing.
How to read the evidence
This is a well-designed discrete-choice experiment, which is the gold standard for quantifying patient preferences. However, it measures stated rather than revealed preferences, and the sample was CGRP therapy-naïve. Industry funding (AbbVie) is a potential source of bias.
When this study was published
Published in 2025 with data collected in late 2020, during the early expansion of CGRP-targeting therapies. Patient preferences may have evolved as real-world experience with these drugs has accumulated.
The bigger picture
The CGRP pathway has become the most important target in modern migraine treatment, with both small molecule peptide receptor antagonists (gepants) and large molecule monoclonal antibodies available. This patient preference data could shift prescribing patterns toward oral gepants as first-line CGRP therapy. It also underscores a broader trend in peptide therapeutics: when oral formulations can match injectable peptide drug efficacy, patients strongly prefer them.
Questions still open
- Do these stated preferences hold up in real-world practice once patients have actual experience with both treatment types?
- Would patients with more severe or chronic migraine show different preferences, potentially favoring the longer-lasting injectable options?
- As more oral CGRP antagonists enter the market, will the preference gap between oral and injectable CGRP therapies widen further?
Common questions
What are CGRP-targeting therapies and why are there different types?
Why might someone choose an injectable CGRP antibody over the oral pill?
Read the original research
Patient preferences for the preventive treatment of episodic migraine in the United States: A discrete-choice experiment.
Headache, 65(9), 1541-1553
Citation
Lipton, Richard B; Gandhi, Pranav; Myers, Kelley; Bussberg, Cooper; Stokes, Jonathan; Nahas, Stephanie J. (2025). Patient preferences for the preventive treatment of episodic migraine in the United States: A discrete-choice experiment.. Headache, 65(9), 1541-1553. https://doi.org/10.1111/head.14974