AAN 2026 | Factors influencing migraine preventive medication selection and treatment outcomes

When physicians prescribe preventive medications for patients with migraine, they always consider many things. For example, headache frequency, headache pain intensity, preventive medications they have tried in the past, and comorbidities, for example. And these factors are also associated with response to these medications. And the ideal situation is that we can prescribe medications that they are more likely to respond to in the future. So we wanted to address this question in this analysis. We used two large-scale databases, and the first one we used is Mayo Clinic electronic health record database, including more than 71,000 patients who had been prescribed one of the preventive medications for patients with migraine. The second one is Mayo Clinic’s headache subspecialty clinic database including around 4,000 patients who have been seen by one of the headache specialists at Mayo Clinic and who have response data to these medications. And we combined these two separate analyses of prescription pattern and response pattern and comprehensively investigated these patterns. And what we saw was there were several factors that were both associated with prescription pattern and response pattern. And for example, patients with migraine with aura they were more likely to be prescribed one of the CGRP monoclonal antibodies and they are also more likely to respond to CGRP monoclonal antibodies compared to patients with migraine without aura; however, there were a few factors that were both associated with prescription pattern and response, but in a different direction. For example, tricyclic antidepressants, this is one of the common medications for patients with migraine, and patients who have depression or anxiety are more likely to be prescribed TCA. However, they were actually less likely to respond to tricyclic antidepressants. And because our study was an observational study, we couldn’t address the underlying mechanisms for these findings. However, we suggest these findings are very, very important to navigate future studies and future clinical practice, and hopefully future studies can address the underlying mechanisms of the findings that we observed.

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