In a survey of 397 Japanese Headache Society members, 81% had prescribed CGRP mAbs, most requiring 2+ prior preventive failures before recommending them, with monthly migraine day thresholds ranging from 4 to 10+ — but cost was the most common barrier to prescribing and the top reason responders discontinued.
Cost: #1 barrierCost was both the most common reason patients asked about CGRP mAbs (media-driven awareness) and the most common reason responding patients stopped treatment — highlighting a critical access gap
What the researchers found
320/397 respondents (81%) had prescribed CGRP mAbs. 55% required ≥2 prior preventive failures. MMD thresholds varied: ≥4 (23%), ≥6 (22%), ≥8 (24%), ≥10 (26%). 70% assessed efficacy at 3 months for episodic migraine. Cost was the top concern: 28% cited it as limiting prescriptions and 24% as the main reason responding patients discontinued.
Why it matters
CGRP antibodies are transforming migraine prevention, but their high cost creates a gap between what's medically optimal and what's practically achievable. This survey quantifies that gap in Japan and reveals significant variability in prescribing thresholds among specialists — information important for guideline development and health policy.
The numbers in context
Japanese CGRP mAb guidelines: ≥4 monthly migraine days and ≥1 previous preventive failure required.
How the study worked
Online survey of Japanese Headache Society physician members. Questions covered prescribing experience, threshold criteria (prior failures, monthly migraine days), efficacy assessment timing, and barriers to treatment. 397 responses analyzed.
Who was studied
Japanese headache specialist physicians
What this study cannot tell us
Survey-based — reflects reported practices, not verified prescribing data. Self-selected respondents may not represent all Japanese prescribers. Japanese healthcare system and CGRP mAb pricing differ from other countries. Physician perspectives may not reflect patient experiences or preferences.
How to read the evidence
Rated preliminary: physician survey with reasonable response rate but inherent limitations of self-reported data. Useful for understanding prescribing patterns but not clinical outcomes.
When this study was published
Published in 2024. Captures current Japanese prescribing practices shortly after all three CGRP mAbs became available in Japan.
The bigger picture
As CGRP antibodies become available in more countries, understanding real-world prescribing patterns and barriers is essential. The cost barrier identified in Japan applies globally — even in countries with different healthcare systems, the high price of biologics limits access to effective migraine prevention.
Questions still open
- How do real-world prescribing patterns in Japan compare to European and American practices?
- Would tiered pricing or biosimilar competition reduce the cost barrier to CGRP mAb access?
- Should guidelines standardize MMD thresholds, or is the current flexibility appropriate?
Common questions
How do doctors decide when to prescribe CGRP migraine drugs?
Why do patients stop CGRP antibodies even when they're working?
Read the original research
CGRP-monoclonal antibodies in Japan: insights from an online survey of physician members of the Japanese headache society.
The journal of headache and pain, 25(1), 39
Citation
Takizawa, Tsubasa; Ihara, Keiko; Watanabe, Narumi; Takemura, Ryo; Takahashi, Nobuyuki; Miyazaki, Naoki; Shibata, Mamoru; Suzuki, Keisuke; Imai, Noboru; Suzuki, Norihiro; Hirata, Koichi; Takeshima, Takao; Nakahara, Jin. (2024). CGRP-monoclonal antibodies in Japan: insights from an online survey of physician members of the Japanese headache society.. The journal of headache and pain, 25(1), 39. https://doi.org/10.1186/s10194-024-01737-y