Trends in migraine-specific medication consumption: a multinational analysis of 73 countries based on IQVIA-MIDAS database, 2015 to 2024

BACKGROUND: Migraine is a highly prevalent neurological disorder and one of the leading causes of disability worldwide. Despite this immense public health impact, real-world utilization of migraine-specific pharmacotherapies across different income levels remains poorly characterized. This study examines longitudinal consumption trends of migraine-specific medications (MSMs) across 73 countries. METHODS: Using the IQVIA-MIDAS database, region/country-level quarterly sales volumes of specific MSMs and propranolol from 2015 to 2024 were extracted and normalized to standard units per 1000 population. Descriptive statistics were summarized using the median, interquartile range (IQR), population-weighted mean and standard error (SE). For stratified analysis, the 73 countries were classified into high-, upper-middle-, and lower-middle-income countries (HICs, UMICs, LMICs). Temporal trends were evaluated using joinpoint regression to calculate the annual percent change (APC). Multiple intervention interrupted time series (ITS) models assessed the sequential impacts of CGRP introduction (May 2018) and the COVID-19 pandemic (January 2020). RESULTS: Between 2015 and 2024, median consumption of all MSMs nearly doubled from 101.77 to 194.39, with population-weighted averages rising from 149.23 to 201.05. The MSM consumption was overwhelmingly concentrated in HICs (337.11 to 378.13), while consumption in UMICs (9.40 to 15.10) and LMICs (18.77 to 28.01) remained persistently low. Acute MSMs, mainly triptans, drove most consumption and showed accelerating growth. Preventive MSM consumption initially declined before rebounding, largely from rapid uptake of CGRP inhibitors in HICs. Propranolol remained the most consistently consumed preventive agent across all income groups. The COVID-19 pandemic coincided with a temporary drop in MSM consumption followed by accelerated long-term growth in several groups. CONCLUSIONS: MSM consumption remains markedly unequal and heavily concentrated in HICs. The advanced CGRP inhibitors represent an important therapeutic advance, while underlying gaps in migraine-specific preventive pharmacotherapy largely unresolved. Addressing these global disparities requires healthcare prioritization aligned with the actual disability weight of migraine.