The global prevalence of migraine was estimated to be 1.1 billion [95% uncertainty interval (UI): 0.98–1.3] cases in 2019. ^{Reference Safiri, Pourfathi and Eagan1} Headache disorders overall were the third leading cause of disability worldwide, associated with approximately 46.6 million years lived with disability (YLDs) in 2019. ^{Reference Steiner, Stovner and Jensen2,Reference Graves, Gerber and Berrigan3} However, there are retrospective Canadian studies showing that less than half of migraine patients were prescribed a triptan. ^{Reference Graves, Gerber and Berrigan3} This is likely due to an underrecognition of migraine as a serious medical disorder in our society as well as underutilization of effective acute medications. With a growing family physician shortage across Canada and increasing wait times to see specialists (including general neurologists and headache specialists), it is crucial to analyze prescribing patterns among primary care providers.

O’Brien et al.’s ^{Reference O’Brien, Grandy and Dawe4} cross-sectional retrospective analysis of their Nova Scotia patient database shows that at least 50% of migraine patients had received appropriate acute management medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) or triptans, and 60.4% were prescribed an approved migraine preventative. These are encouraging data and may signal the beginning of a shift in migraine recognition and medication prescribing patterns. The main limitation in this study is that we cannot know for certain whether NSAIDs or some preventatives (like antihypertensive or antidepressants) were used specifically for migraines or other comorbid disorders.

As more migraine-specific medications enter the market, such as gepants and calcitonin-gene related peptide (CGRP) monoclonal antibodies, prescription patterns should change with increased education around these new agents and the publication of our new migraine preventative guidelines. ^{Reference Medrea, Cooper and Langman5} These retrospective studies can be more migraine-specific when analyzing for these newer medications and provide information on prescription patterns to ensure that guidelines are being applied effectively. If a certain area or province is lagging behind, outreach education programs can be administered to address these disparities.

We need ongoing studies to ensure that migraine is being recognized and diagnosed by primary care providers. This is essential to being an effective medical team with local neurologists to ensure that migraine-specific medications are being administered to migraine patients as soon as possible to lower migraine burden early, prevent migraine chronification and reduce years of disability.