Migraine patients saw an average of 4.1 healthcare providers before diagnosis, with 31% reluctant to seek help and 20% initially given a different diagnosis, revealing major barriers to reaching CGRP antibody treatment.
4.1 doctors before diagnosisMigraine patients saw an average of 4.1 healthcare providers before receiving their correct diagnosis, with 20% initially given a different diagnosis
What the researchers found
500 patients surveyed (250 EM, 250 CM, 90% female). Mean 4.1 healthcare providers seen before diagnosis. 71% suspected migraine before diagnosis. 31% reluctant to seek care. 20% initially misdiagnosed. Prior preventives included anticonvulsants (61%), antidepressants (44%), blood pressure meds (43%), botulinum toxin (17%). Most discontinuations due to lack of efficacy or side effects.
Why it matters
Understanding the patient journey reveals systemic barriers to effective migraine care. If patients see 4+ doctors before diagnosis and many are reluctant to seek help, CGRP antibody treatments — though effective — may not reach those who need them most without addressing these upstream problems.
The numbers in context
Survey of patients in the Emgality Patient Support Program (2022).
How the study worked
Cross-sectional self-reported online survey of 500 subjects (250 episodic, 250 chronic migraine) enrolled in Lilly's Emgality Patient Support Program in 2022. Collected data on migraine history, diagnostic journey, healthcare interactions, and treatments before CGRP antibody initiation.
Who was studied
Patients in Lilly's Emgality Patient Support Program (2022 survey)
What this study cannot tell us
Selection bias — survey participants were already in a manufacturer's support program and may not represent all migraine patients. Self-reported data subject to recall bias. Sponsored by Eli Lilly (Emgality manufacturer). Cross-sectional design cannot establish causation for treatment delays.
How to read the evidence
Rated preliminary: cross-sectional survey with selection bias (manufacturer support program) and self-reported data. Provides valuable patient perspective but not generalizable epidemiological data.
When this study was published
Published in 2024, based on 2022 survey data. Reflects the patient experience era where CGRP antibodies are available but access barriers persist.
The bigger picture
Despite revolutionary CGRP-targeting treatments being available, this survey shows the healthcare system still fails many migraine patients through delayed diagnosis, stigma, and inadequate early treatment. Improving primary care migraine education and reducing patient barriers could accelerate access to effective peptide-based therapies.
Questions still open
- Would earlier access to CGRP antibodies — before cycling through multiple failed preventives — improve long-term outcomes?
- How can primary care physicians be better trained to diagnose migraine earlier and consider CGRP antibodies sooner?
- Do the barriers identified differ across racial, ethnic, and socioeconomic groups?
Common questions
Why does it take so long to get migraine treatment?
What treatments do migraine patients try before CGRP antibodies?
Read the original research
Patients' Experiences During the Long Journey Before Initiating Migraine Prevention with a Calcitonin Gene-Related Peptide (CGRP) Monoclonal Antibody (mAb).
Pain and therapy, 13(6), 1589-1615
Citation
Seng, Elizabeth; Lampl, Christian; Viktrup, Lars; Lenderking, William R; Karn, Hayley; Hoyt, Margaret; Kim, Gilwan; Ruff, Dustin; Ossipov, Michael H; Vincent, Maurice. (2024). Patients' Experiences During the Long Journey Before Initiating Migraine Prevention with a Calcitonin Gene-Related Peptide (CGRP) Monoclonal Antibody (mAb).. Pain and therapy, 13(6), 1589-1615. https://doi.org/10.1007/s40122-024-00652-z