Treatment Patterns, Characteristics, and Probable Acute Medication Overprescription Among Patients With Migraine in Japan: A Retrospective Cross-Sectional and Longitudinal Analysis of Health Insurance Claims Data

Objective This study aimed to investigate prescription patterns for migraine patients aged 18 years and older using the REZULT database, managed by Japan System Techniques Co., Ltd. in Tokyo, Japan. Methods The study used data from employee-based insurance claims within the REZULT database and comprised two components. In the first part, a cross-sectional analysis (Study 1) was conducted to determine the rate of acute medication overprescription among patients diagnosed with migraines in 2020. Overprescription was defined as receiving at least 30 tablets within 90 days for triptans, combination nonsteroidal anti-inflammatory drugs (NSAIDs), or multiple types of medications, or at least 45 tablets for single NSAIDs within the same period. The second component, Study 2, involved a longitudinal analysis, tracking patients for more than two years from their initial migraine diagnosis, covering the period from July 2010 to April 2022. The number of prescribed tablets was recorded every 90 days. Results In Study 1, out of 3,300,705 patients evaluated in 2020, 66,428 (2.01%) were diagnosed with migraines. Of these, 41,209 (62.04%) received acute medications. Overprescription was observed in 9,280 patients (22.52%) for single NSAIDs and in 2,118 patients (5.14%) for triptans. Additionally, 6,412 patients (15.56%) received prophylactic treatment. In Study 2, among 6,840,618 patients followed for more than two years, 296,164 (4.33%) had a persistent diagnosis of migraines over the study period. Overprescription rates were 23.20% (68,704 patients) for single NSAIDs and 3.97% (11,755 patients) for triptans, while 48,886 patients (16.51%) received prophylactic medication at least once. The treatment patterns were influenced by socioeconomic factors, such as the area deprivation index, and the distribution of headache specialists. Conclusions Our assessment of real-world data revealed that prophylactic medications are underprescribed, while moderate to high rates of acute medication overprescription were noted among migraine patients.