Most migraine patients starting injectable CGRP antibodies also received acute CGRP-targeting medications, with dual CGRP-pathway treatment being the dominant real-world prescribing pattern.
3,497 patientsReal-world analysis showing most migraine patients on CGRP injections also received acute medications targeting the same peptide pathway
What the researchers found
Among 3,497 migraine patients initiating self-injectable CGRP monoclonal antibodies alongside novel acute medications, the majority had chronic migraine (64.4–71.4%) and were already on both preventive and acute treatments. Most patients received combination therapy with both preventive and acute medications targeting the CGRP pathway — either both binding CGRP receptors (43.6–59.0%) or preventive medication binding CGRP ligands paired with acute medication binding CGRP receptors (34.9–51.9%).
Patients used both medications concurrently for an average of about 30 days, and prescribing patterns were consistent across different healthcare provider types.
Why it matters
CGRP-targeting peptide therapies represent a major breakthrough in migraine treatment. This study provides the first real-world look at how doctors are actually combining these new preventive and acute CGRP medications, revealing that dual CGRP-pathway targeting is the dominant prescribing pattern — information that can guide treatment decisions and insurance coverage policies.
The numbers in context
n=3,497 total · 64.4–71.4% chronic migraine · 88.8% female · Mean age 44.7–51.2 years · ~30 days concomitant use · 43.6–59.0% dual CGRP receptor targeting
How the study worked
Retrospective observational study using insurance claims data from IBM MarketScan Research Database and Optum's Clinformatics Data Mart (May 2017–December 2020). Included adult patients initiating self-injectable CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab) alongside novel acute medications (lasmiditan, rimegepant, ubrogepant) with at least 3 months of overlapping use.
Who was studied
Adult migraine patients initiating self-injectable CGRP monoclonal antibodies with novel acute migraine medications, predominantly female (88%), mean age mid-40s to early 50s
What this study cannot tell us
As a claims-based observational study, it cannot measure treatment effectiveness, patient-reported outcomes, or reasons for prescribing decisions. Claims data may not capture medication samples, over-the-counter use, or non-adherence. The study describes patterns but cannot establish whether dual CGRP-pathway targeting produces better outcomes than other combinations.
How to read the evidence
This is a retrospective observational study using insurance claims data. It describes prescribing patterns but cannot measure treatment effectiveness. Evidence grade reflects the descriptive, non-interventional design.
When this study was published
Published in 2022 using data through December 2020, this captures early real-world prescribing patterns for CGRP therapies. Treatment patterns may have evolved as clinicians gained more experience with these relatively new peptide medications.
The bigger picture
CGRP-targeting therapies have transformed migraine treatment since their approval starting in 2018. This study reveals that real-world prescribing has rapidly moved toward combining multiple CGRP-pathway drugs — a practice that outpaced clinical trial evidence. Understanding these patterns helps inform future research priorities and insurance formulary decisions for peptide-based migraine therapies.
Questions still open
- Does combining preventive and acute CGRP-targeting medications produce better migraine outcomes than using just one?
- Are there safety concerns with sustained dual CGRP-pathway blockade that claims data cannot detect?
- How do treatment patterns differ for patients who don't respond to initial CGRP monotherapy?
Common questions
What are CGRP monoclonal antibodies and how do they treat migraine?
Is it common to use both preventive and acute CGRP medications together?
Read the original research
Patient characteristics and treatment utilization among patients with migraine initiating self-injectable calcitonin gene-related peptide monoclonal antibody and novel acute medication.
Current medical research and opinion, 38(8), 1451-1457
Citation
Varnado, Oralee J; Hoyt, Maggie; Ye, Wenyu; Nicholson, Robert. (2022). Patient characteristics and treatment utilization among patients with migraine initiating self-injectable calcitonin gene-related peptide monoclonal antibody and novel acute medication.. Current medical research and opinion, 38(8), 1451-1457. https://doi.org/10.1080/03007995.2022.2091333