The California Workers’ Compensation Institute (CWCI) released a new report that explores how migraine drugs are making up a greater portion of drug spend in the California workers’ comp system.

While migraine drugs represent less than 1% of all prescriptions dispensed, their financial footprint has grown dramatically, jumping from 0.5% of drug spend in 2018 to 7.5% in 2025. They are now the third most expensive drug group in California, behind only dermatologicals and anti-inflammatories.

Much of this growth is due to CGRP drugs, a newer class of medications that are still primarily available in brand-name versions, and which are seeing greater utilization across healthcare, as the American Headache Society added CGRP drugs to the list of first-line treatments for the prevention of migraines. This trend could continue further, as CGRP migraine drugs were added to California’s Workers’ Compensation Formulary drug list for the treatment of traumatic brain injuries, which along with evolving clinical recommendations, may increase the likelihood that these drugs will be approved following utilization review or independent medical review.

While migraines sometimes result from traumatic brain injuries or concussions sustained in workplace accidents, where causation is relatively clear cut, they may also arise following other injuries or be triggered by factors such as light, sound, odors, or stress, where workplace causation is more difficult to determine.