Migraines are a neurobiological disorder that impact patients’ quality of life. New therapies are offering promising improvements in migraine prevention and treatment, and managed care organizations will need to understand how to integrate these advancements into practice, according to a session at the AMCP 2025 Annual Meeting.
Migraines are one of the leading causes of disability, affecting approximately 40 million US adults (12% of the population). In addition, 40% to 50% of adults who have migraines are undiagnosed.
Migraines are also the second leading contributor to years lived with disability, causing people to miss work or experience reduced productivity. Appropriate migraine treatment may address this productivity challenge.
The annual burden of migraines is estimated to be more than $56 billion, 60% of which is attributed to direct costs.
Migraines are also associated with an increased risk of depression and anxiety due to the chronic pain and life disruptions. The suicide rate is elevated in this population, with 7.21% of adults with migraines attempting suicide versus 2.7% of the general adult population.
The American Headache Society 2024 Position Statement recommends calcitonin gene-related peptide (CGRP)–targeted therapies as first-line preventive treatment for migraines and monoclonal antibodies targeting CGRP or its receptor. Gepants can also be used for acute or preventive treatment of migraines. Both anti-CGRP monoclonal antibodies and gepants are generally well tolerated by these patients.
Goals of acute treatment should focus on:
- Rapid consistent freedom from pain and symptoms
- Restored functionality
- Minimal repeat dosing or use of rescue medications
- Optimal self-care and reduced subsequent use of resources (eg, emergency department visits, imaging, office visits)
- Minimal or no side effects
Goals of migraine prevention include:
- Reducing attack frequency, severity, duration, and disability
- Lowering treatment costs
- Improving health-related quality of life
- Enabling self-management
Although about 40% of patients with migraine are eligible for preventive therapy, less than one-fifth receive it, and just 50% of patients adhere to oral preventive medications due to side effects and perceived inefficacy.
The costs for novel migraine therapies can present challenges for patients and payers, and cost calculations should incorporate reduced acute medication use; decreased emergency and urgent care visits; improved productivity; and reduced disability costs.
This session was supported by an independent medical education grant from Pfizer, Inc.
Reference
Bioc J, Joshi S, Stone SL. Mind over migraines: disease burden, innovative therapies, and managed care trends in treating migraines. Presented at: AMCP 2025; March 31-April 3, 2025; Houston, TX. Session D5.
