(324) Use of migraine medications during pregnancy and among women of childbearing age

Background: There is limited knowledge about use of migraine medications during pregnancy in the U.S., particularly since the approval of several new medications that target calcitonin-gene related peptide (CGRP).

Objectives: To quantify dispensings of migraine medications in two cohorts of patients with migraine: women of childbearing age (WCA) and pregnancies.

Methods: Within the Optum Research Database, a claims database from a large U.S. health insurer, women aged 16-44 years with a diagnosis of migraine (ICD-10 G43*) during 2020-2022 were identified. Among these women, we further identified pregnancies that began during the study period using Optum’s Dynamic Assessment of Pregnancy and Infants. We described patient characteristics and utilization of acute (acetaminophen, antiemetics, ergot-derivatives, gepants, nonsteroidal anti-inflammatory drugs [NSAIDs], opioids, triptans) and preventive (angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, antiepileptics, beta-blockers, botulinum toxins, calcium-channel blockers, CGRP monoclonal antibodies, and several antidepressants) migraine medications in each cohort.

Results: We identified 216,491 WCA with migraine and 13,026 pregnancies. The median age was 33 years in the WCA cohort and 31 years in the pregnancy cohort. Among WCA, the most frequently dispensed acute migraine medications were triptans (37.7%) and NSAIDs (30.7%). The most common preventive migraine medications were antiepileptics (19.2%) and beta-blockers (10.8%). Use of most medications was lower in the pregnancy cohort compared with the WCA cohort. During pregnancy, the most frequently dispensed acute medications were antiemetics (36.1%) and NSAIDs (12.6%); the most frequently dispensed preventive medications were beta-blockers (3.6%) and antiepileptics (3.0%). Dispensings of most migraine medications decreased across each trimester of pregnancy. Use of CGRP antagonists was relatively uncommon: 3.0% and 5.6% of WCA were exposed to gepants and CGRP monoclonal antibodies, respectively; the corresponding percentages were 0.5% and 1.2% among pregnant women.

Conclusions: Among WCA with migraine, use of acute migraine medications was greater than preventive medications, particularly among women who were pregnant. Dispensings of most migraine medications declined throughout pregnancy; among the medications assessed, antiemetic agents were the most frequently dispensed during pregnancy. Use of CGRP antagonists was low compared to other medications, which may be due to requirements for prior authorization or a step-through therapy (i.e., failure of standard of care medications) for these newly approved migraine treatments.