Migraine Drugs Are Third-Most Expensive Category in California Workers’ Compensation, Study Finds

Migraine drugs are among the most expensive drug categories in California’s workers’ compensation system, a new report has revealed. 

Migraine medicines are the third-most expensive drug category, fueled primarily by the use of new, high-cost Calcitonin Gene-Related Peptide (CGRP) targeted medications, according to the latest prescription data from the California Workers’ Compensation Institute (CWCI).

Despite migraine drugs accounting for less than 1% of all prescriptions dispensed to injured workers in the first half of 2025, their medical footprint has skyrocketed since 2018, according to the CWCI. 

Migraine drugs now rank only behind dermatological drugs and anti-inflammatories.

According to the recent update to CWCI’s Prescription Drug Data Application, the share of migraine drugs in California workers’ compensation prescriptions has been rising in the past few years, but is still relatively small. 

Although the share of migraine drugs in workers’ compensation rose from 0.2% to 0.9% between 2018 and the first half of 2025, their share of the total drug spend in the system increased from 0.5% to 7.5%, according to the Institute.

Data shows that a large part of this sharp jump was linked to the CGRP migraine drugs, a new category of medications that specifically prevent or treat migraines. 

Unlike older therapies, most of which are affordable generic medicines, the CGRP drugs are significantly higher-cost, brand-name specialty medications that are patented. 

The CGRP drugs’ increasing prevalence is proving to be challenging for employers, claims administrators, pharmacy benefit managers, and attorneys handling work injury claims, according to the Institute. 

The CWCI said that migraines are often caused by traumatic brain injuries or concussions during workplace accidents, and may also happen after other injuries, or can be triggered by factors like light, sound, odors, or stress. 

The Mayo Clinic defines migraine as a headache that can result in intense throbbing or pulsing pain, usually on one side of the head. Migraine attacks can typically last for hours to days, and can interfere with daily activities. 

Once accepted as compensable, migraine claims may now involve expensive, long-term treatment, especially when CGRP drugs are part of the care plan, according to the Institute. 

The CWCI pointed out that broader healthcare trends have also led to increased use of migraine drugs, including direct-to-consumer advertising, aggressive marketing, more physician familiarity with CGRP drugs, and surging patient demand. 

In April 2026, multiple CGRP migraine medications were added to California’s Workers’ Compensation Formulary drug list to treat traumatic brain injuries, according to the CWCI. 

In addition, the evolving clinical recommendations are likely to result in these drugs getting approved following utilization review or independent medical review. 

While these drugs may bring relief to some workers, the Institute noted that compensation professionals should ensure that they are being used appropriately. 

The potential side-effects, long-term liabilities, and increasing financial burden of these new drugs should raise questions about alternative therapies, treatment duration, patient screening, cost-effectiveness, and long-term outcomes, the Institute said. 

The CWCI is a private, nonprofit organization of insurers licensed to write workers’ compensation in California. The Institute collects and analyzes claims data to improve benefit delivery to injured workers, identify trends, help members in calculating their operations, and address critical areas of interest to the workers’ compensation community and policymakers.