Headache medicine has been revolutionized by the advent of new migraine-specific therapies that have come along from bench to bedside.Reference Tepper ¹ These medications, the calcitonin gene-related peptide (CGRP) inhibitors, have been in use clinically in Canada since 2018 and have received strong recommendations for their use from Canadian prevention guidelines. ^{Reference Medrea, Cooper and Langman2} These medications include acute treatment options, which are not the focus of this article. This article focuses on preventive options in this class. As a physician practicing in this space since the introduction of these medications, I am certainly grateful we have new options for our patients, but this article asks important questions about resource utilization changes that are brought on by these medications and the persistence of patients on these medications. These treatments are expensive, and we want to make sure we are getting some benefit in our government-funded healthcare system. The paper by Randall et al. looks at the trends in acute medication use, healthcare utilization and adherence to these medications in six Canadian provinces from 2018 to 2023, with data presented per year of use.Reference Randall, Martins and Luu ³

Randall et al. in this important paper on the Canadian landscape of anti-CGRP use find that in patients using these medications, there is a decrease in headache medication supply of 16 days/year. Additionally, there was a reduction of 1.82 in healthcare visits per year. These were 1.65 fewer physician visits per year and 0.14 fewer emergency room visits. In terms of adherence, a total of 30.4% of patients discontinued these medications, with 21.3% switching to onabotulinumtoxinA or other oral therapies, 5.4% switching to other anti-CGRP therapies and 9.2% stopping therapy. When comparing this discontinuation rate to older oral preventives, for which up to 80% of patients discontinued the medication, this is a relatively a good rate of continuing on therapy.Reference Hepp, Dodick, Varon, Gillard, Hansen and Devine ^{4 ,} Reference Hepp, Dodick and Varon ⁵ Overall, in this paper, there is emerging evidence that in a Canadian setting, the use of anti-CGRP medications leads to less acute medication use, fewer healthcare visits and numerically better adherence than older oral preventive therapies. This finding is encouraging for the continued use of these therapies that have been clinically beneficial and have added to our arsenal for the treatment of migraine.