Underutilization of Modern Migraine Therapies

Despite the availability of advanced migraine treatments, many patients continue to rely on traditional, less effective medications. Neurologists have expressed concern about the slow adoption of CGRP (Calcitonin Gene-Related Peptide) therapies, which have proven to be a significant advancement in preventing frequent and severe migraine attacks.

Dr. Lars Neeb, president of the German Migraine and Headache Society (DMKG), noted that numerous patients endure years of unsuccessful treatment with non-specific prophylactic medications, such as beta-blockers. He highlighted the need for a more proactive approach, suggesting that early intervention with CGRP therapies could prevent the chronic progression of migraines.

A chronic migraine diagnosis is given to individuals experiencing 15 or more migraine days per month. According to the Kiel Pain Clinic, this condition affects approximately 1 to 2 percent of the population in Germany, equating to around 1.66 million people. General migraine prevalence is reported at 15 percent, with 2.5 percent of individuals with episodic migraines developing chronic migraines.

Since the introduction of Erenumab (Aimovig®) in 2018, which targets the CGRP receptor, several other CGRP inhibitors have become available, including Eptinezumab, Fremanezumab, and Galcanezumab. These medications are approved for migraine prevention in patients suffering from at least four migraine days per month. More recently, two orally administered CGRP inhibitors, Atogepant (Aquipta®) and Rimegepant (Vydura®), were approved in early 2025.

However, the high costs associated with these therapies often lead to patients being treated with conventional, less effective medications for extended periods before CGRP inhibitors are considered. Typically, these advanced treatments are prescribed only after traditional medications have failed, are not tolerated, or are contraindicated.

In summary, despite the advancements in migraine treatment, the full potential of modern therapies remains untapped. There is an urgent need for healthcare professionals to recognize the importance of early intervention with CGRP therapies to improve patient outcomes and reduce the burden of chronic migraines.