Prescribing patterns of migraine pharmacotherapy in children and adolescents: descriptive study using a large-scale claims database.

BACKGROUND: Treatment options for pediatric patients are more limited than for adults. Data on pediatric migraine treatment practices, overprescription, and long-term prescription patterns are limited. The study aimed to describe the incidence of overprescription of acute medications and prescription patterns in children and adolescents. METHODS: A descriptive study was conducted using data from the JMDC claims database between April 2012 and March 2025. We included patients with migraine aged 6-17 years. The cumulative incidence of overprescription was estimated for acute medications. The longitudinal prescription patterns of acute and preventive medications were summarized on Days 0, 30, 60, 90, 180, 270, and 365 using Sankey plots. Analyses were stratified by age group (6-11 and 12-17 years). RESULTS: The study included 27,074 pediatric patients with migraine; 6495 were aged 6-11 years, and 20,579 were aged 12-17 years. The 5-year cumulative incidence of overprescription was 4.86% for NSAIDs, 1.55% for triptans, and 3.13% for acetaminophen. Overprescription was more frequent in adolescents than in children (NSAIDs 5.56% vs 2.46%). At Day 0, 40.1% of patients received analgesics alone, 13.1% received triptans/ergotamine alone, 13.0% received combination therapy, and 24.4% received prescriptions including preventive medications. By Day 365, these figures had decreased to 3.7%, 1.0%, 0.8%, and 9.1%, respectively. CONCLUSION: Among pediatric patients with migraine, overprescription was more common in adolescents than in younger children. All prescription regimens decreased over time, but preventive medications appeared relatively persistent compared with acute medications.