To assess the real-world medication usage and switch profile of Calcitonin Gene-Related Peptide Receptor (CGRP) monoclonal antibody (mAb) and antagonist (gepant) medications at a tertiary headache center.

Patients with refractory migraine often undergo multiple unsuccessful medication treatments with limited improvement. To date, the efficacy of CGRP mAb and gepant medications has been established in both episodic and chronic migraine patients. However, data regarding these medications’ switch profiles and effects on patient headache burden remain limited and understudied.

This retrospective study was conducted at Jefferson Headache Center (JHC), a tertiary headache facility. Electronic medical record data from patients with a diagnosis of migraine seen by JHC providers for at least two visits from December 1, 2018 to March 25, 2023 was analyzed with respect to patient demographics, ambulatory encounter diagnoses, medication orders, and outcomes from patient surveys.

Out of a total of 7,997 patients with migraine, we identified 2,900 individuals prescribed at least one CGRP mAb, with a mean age of 49.5, 2,551 (81.1%) were female, 2,534 (87.4%) were white, and 178 (6.1%) were black. Of the 2,900 patients, 875 switched ≥1 CGRP mAb (30.2%), and 171 switched ≥2 CGRP mAbs total (19.5%). Of the patients that did not switch CGRP mAbs, the highest proportion was those on erenumab (40.4%), followed by fremanezumab (33.3%), and the most common switch pattern was erenumab to fremanezumab (26.0%).  Of the total patients with migraine, 3,302 (41.3%) patients had been prescribed at least one gepant medication: ubrogepant (1,123, 34.0%), rimegepant (1,073, 32.5%), and atogepant (66, 2.0%).

We describe the CGRP mAb and gepant medication usage and switch profiles at JHC. Further investigation into the reason for the switch and its effect on headache outcomes remains to be conducted.