Gepants and monoclonal antibodies (mAbs) against calcitonin gene-relate peptide (CGRP) have transformed the treatment paradigm for migraine. Despite the availability of a plethora of drugs in the market in recent years, key barriers still stand in the way of their widespread use – particularly a low migraine diagnosis rate. Therefore, closing the diagnosis gap is imperative for improving migraine treatment and should be addressed through new education and awareness initiatives, says GlobalData, a leading data and analytics company.

According to high prescriber survey results collected by GlobalData, only 49% (on average) of those with migraine have been diagnosed across the seven major markets (7MM: The US, France, Germany, Italy, Spain, the UK and Japan).

Christie Wong, Pharma Analyst at GlobalData comments: “In the past three years, seven different agents targeting CGRP have been launched in the US, offering acute and prophylactic treatment of migraine. The availability of these drugs has addressed a significant amount of ‘unmet need’ in the market as they are well tolerated, produce freedom from headache and/or reduce the mean number of monthly migraine days. Furthermore, unlike the triptans, the gepants and mAbs against CGRP can be used in patients with or at risk of cardiovascular disorders.”

While treatments for migraine have improved in recent years, they can only have an impact if a patient is formally and correctly diagnosed with the condition. Key opinion leaders (KOLs) interviewed by GlobalData noted that insufficient physician education and awareness of the disease in the general population were the biggest hurdles for improving migraine treatment.

Ms. Wong continues: “A lack of knowledge among the physicians and an insufficient consultation time allowed for discussions of patient’s histories are to blame for the low diagnosis rates. Additionally, migraine is often misdiagnosed due to the absence of a specific diagnostic test and the similarity of migraine to other indications such as tension type headache. Misdiagnosis can result in patients potentially taking medication that is not specific for their type of attack, which may actually make the symptoms worse.”

Due to easily accessible over-the-counter (OTC) painkillers, patients can be resistant to seeking out care from primary care physicians, neurologists, or headache specialists when necessary. Furthermore, the general population often misunderstands migraine symptoms and may be unaware of the superior therapeutic options available. OTC non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol/acetaminophen are far less efficacious in aborting migraine headaches compared to migraine-specific acute treatments such as the triptans, ergot alkaloids, gepants, and ditans. They also cannot act as preventative therapy like certain gepants and the CGRP-targeting mAbs. Moreover, overuse of NSAIDs and paracetamol/acetaminophen is likely to induce medication-overuse headaches.

Ms. Wong concludes: “Although recent launches of drugs targeting CGRP may have rekindled some interest in the migraine therapeutic area among clinicians and patients, increased outreach regarding disease awareness and education is necessary to ensure these drugs are accessible to patients in need. These initiatives could help boost diagnosis rates and accuracy. In turn, this will increase rates of specialist prescribed treatment and improve disease management.”