Migraine management in England highlights gaps in diagnosis and treatment

A retrospective CPRD Aurum study of 1.53 million adults (2012–2023) found that 57.1% of primary-care headache cases were unclassified, 62.6% of patients with migraine received acute treatments within 12 months, and only 36.5% received preventive medication; over 40% of opioid and analgesic users had doses consistent with medication overuse.

Researchers used the Clinical Practice Research Datalink (CPRD) Aurum in a retrospective cohort study to examine diagnosis and treatment patterns for adults with headache or migraine in England between September 2012 and May 2023. The analysis included 1,534,807 patients registered with a general practitioner for at least 12 months and looked at prescriptions issued in the 12 months after diagnosis. The study compared prescribing patterns with SIGN155/NICE CKS dose guidance where possible. It was published online January 9, 2026, in BJGP Open. Key findings: - 57.1% of headache cases recorded in primary care were undifferentiated or unclassified, and among primary headache disorders migraine accounted for 78.5% of cases. - Among patients with migraine who had not previously received specific migraine medication, 62.6% were prescribed acute treatments (mainly triptans and NSAIDs) within 12 months. - Only 36.5% of patients with migraine received a preventive medication; tricyclic antidepressants and beta-blockers were the most commonly prescribed preventive classes. - Over 40% of opioid and analgesic users were prescribed doses consistent with medication overuse; the data showed relatively low percentages of patients reached recommended doses for medications covered by SIGN155/NICE CKS, and the study noted limitations including inability to determine prescription reason and lack of over-the-counter and secondary care medication records. The study was funded by Pfizer Ltd and includes author disclosures related to Pfizer. Summary: The study reports persistent underclassification of headache in primary care and gaps between prescribing patterns and guideline-referenced dose guidance, including notable use of opioids. Undetermined at this time.