Migraine Prevention Drugs Rarely Kept Up in German Claims Data Study

Most patients who later switched to a newer class of migraine preventive drug had not stayed on their earlier conventional preventive treatments for long, according to a retrospective cohort study based on German statutory health insurance claims data. Researchers analyzed prescription records for migraine patients who received a first prescription of an anti-calcitonin gene-related peptide monoclonal antibody (aCGRP-mAb) between October 1 and December 31, 2021, and who had uninterrupted retrospective data covering the preceding five years. Their goal was to measure how long patients persisted with established oral preventive drugs and with botulinum neurotoxin type A (BoNTA) under real-world conditions before turning to the newer antibody therapies.

The study defined prevalent migraine patients as individuals over 18 years of age with at least one ICD-10 G43 diagnosis. For the analysis of conventional therapies, the researchers identified a cohort of 137 patients, of whom 119 were female and 18 were male. During the five-year observation window before their first monoclonal antibody prescription, these patients received an average of 2.6 conventional preventive therapies, indicating that many had tried and moved through multiple preventive drugs in the years leading up to the switch.

Persistence was defined strictly: 180 days of uninterrupted preventive therapy with the same drug as the first prescription. Prescription duration was estimated from the therapeutic range per prescribed package according to the prescribing information, and Kaplan-Meier survival analyses were used to evaluate the time until treatment discontinuation. By this criterion, the results were striking. For most of the preventive drugs examined, fewer than five patients in the cohort fulfilled the 180-day persistence requirement, a remarkably low number given the 137 patients analyzed.

The study also documented a substantial gap between conventional therapies and the newer antibody treatments. On average, patients began therapy with a monoclonal antibody more than one year after the last previous conventional preventive therapy was dispensed.

The authors caution that the observed low persistence of oral preventive migraine treatments, which were not specifically developed for migraine prevention, could indicate either temporary relief from migraine or treatment discontinuation for reasons that could not be identified from the data used in the study. Claims data record what was dispensed, not why treatment ended, whether patients experienced side effects, or whether their migraines improved. The retrospective design also means the analysis captures prescription behavior rather than clinical outcomes, and the cohort is limited to patients who eventually received a monoclonal antibody prescription, which may not represent all people with migraine in Germany.

Context for the burden of the condition comes from epidemiological figures cited in the study: in the global population aged 20 to 99 years, migraine shows the second greatest loss of disability-adjusted life years, and in Germany migraine affects around 15 percent of all women and 6 percent of all men. Migraine preventive therapy aims to reduce the frequency, severity and duration of attacks, making sustained use of preventive medication a central concern for both patients and health systems.

The researchers conclude that further systematic investigations comparing the persistence of conventional preventive therapies and aCGRP-mAbs in routine clinical practice in Germany are warranted. Such comparisons would help clarify whether the newer antibody treatments, developed specifically for migraine prevention, achieve better real-world persistence than the older oral drugs, a question this retrospective claims-data study was not designed to answer directly.

Subject of Research: Persistence of conventional pharmacological migraine prevention therapies before aCGRP monoclonal antibody treatment in Germany

Article Title: Persistence of pharmacological migraine prevention based on statutory health insurance claims data from Germany: a retrospective cohort study

Article References: Domdey, A., Gscheidle, S., Löhr, H., Maier, P. M., & Arnold, M. (2026). Persistence of pharmacological migraine prevention based on statutory health insurance claims data from Germany: a retrospective cohort study. Frontiers in Health Services, 6, Article 1934185. https://doi.org/10.3389/frhs.2026.1934185

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DOI: 10.3389/frhs.2026.1934185

Keywords: migraine, migraine prevention, persistence, health claims data, aCGRP monoclonal antibodies, botulinum neurotoxin type A, Kaplan-Meier analysis, retrospective cohort study, Germany, statutory health insurance, real-world evidence, pharmacological