To compare the first prescription medications for newly diagnosed migraine by prescriber specialty for neurologists and primary care providers (PCPs).

Numerous medications are available for the acute treatment or prevention of migraine; differences may exist in prescribing patterns between neurologists and PCPs.

We included 154,353 patients; 94,198 (61.0%) were prescribed acute treatment and 62,596 (40.6%) prevention. Patients prescribed their first migraine medication by neurologists were younger, more likely to also have other primary or secondary headaches, and less likely to have cardiovascular risk factors. For the first acute medication, neurologists were more likely to prescribe triptans (73.5% vs. 47.4%, p<0.0001) and CGRP small-molecule antagonists (13.7% vs 3.5%, p<0.0001), and less likely to prescribe NSAIDs (15.6% vs 51.1%; p<0.0001); median time from migraine diagnosis to first acute medication was shorter for neurologists (73 vs. 181 days; p<0.0001). For the first preventive medication, neurologists were more likely to prescribe anticonvulsants (33.7% vs 20.6%, p<0.0001) or CGRP-mAbs (19.9% vs. 5.7%; p<0.0001), and less likely to prescribe beta blockers (11.1% vs 25.8%; p<0.0001) or SNRIs (7.2% vs. 18.8%, p<0.0001); median time from migraine diagnosis to first preventive medication was shorter for neurologists (115 vs. 281 days; p<0.0001).

Significant differences were noted between neurologists and PCPs in the first medications prescribed for acute treatment or prevention of newly diagnosed migraine.