The Migraine Care Gap: A Qualitative Analysis of Patients’ Perspectives on Medical Progress and Persistent Unmet Needs

Despite remarkable advances in migraine diagnosis and treatment, it remains unclear to what extent these developments have translated into meaningful improvements in the everyday lives of people living with migraine. This qualitative study explored how patients perceive the evolution of migraine care over the past decade and identified persistent unmet needs from their perspective. A qualitative exploratory study was conducted using reflexive thematic analysis. The dataset comprised 446 publicly available patient narratives posted in response to an Instagram Reel and a corresponding Facebook post inviting individuals with migraine to reflect on changes in migraine care over the previous 12 years. Comments describing personal experiences with diagnosis, treatment, healthcare delivery, social participation and future expectations were analysed inductively following the methodological framework proposed by Braun and Clarke. Analysis identified four overarching conceptual domains. Participants consistently acknowledged substantial progress in migraine medicine, particularly through migraine-specific acute therapies, calcitonin gene-related peptide (CGRP)-targeted preventive treatments, specialised headache services and improved access to disease-related information. However, these advances were perceived as only partially reflected in clinical practice and everyday life. Persistent barriers included delayed diagnosis, unequal access to specialised care, reimbursement restrictions, workplace challenges, stigma and limited societal recognition of migraine as a disabling neurological disorder. Patients defined treatment success far more broadly than reductions in monthly migraine days, emphasising restored participation, autonomy, predictability, self-efficacy and quality of life. Across all themes, a recurring discrepancy emerged between rapid biomedical innovation and the slower evolution of healthcare delivery and social recognition, conceptualised as the Migraine Care Gap. Patients perceive migraine care as having undergone substantial scientific progress while continuing to experience important medical, structural and societal shortcomings. These findings suggest that future advances should extend beyond therapeutic innovation and include earlier diagnosis, equitable access to specialist care, structured patient education, multidisciplinary management and broader implementation of patient-centred outcome measures. Closing the Migraine Care Gap may represent a key challenge for the next stage of migraine care.