Background &amp; objectives <p>Prophylactic treatment plays a crucial role in reducing the frequency, severity, and duration of migraine attacks. This study, the first to address this issue in Egypt, aimed to study the patterns of prophylactic treatment utilization among individuals with migraine and assess adherence to prescribed regimens.</p> Methods <p>A cross-sectional study was conducted on 200 individuals with migraine. Headache was assessed as follows: type of migraine, duration of attacks, frequency of headache per month, disability using the Migraine Disability Assessment Scale (MIDAS) and headache severity using a visual analog scale (VAS), and treatment history. Prophylactic treatments were evaluated regarding type, dose, adherence using Adherence to Refills and Medications Scale (ARMS) and efficacy using monthly migraine days (MMD) as well as adherence predictors were assessed.</p> Results <p>In our cohort, the median age was 32 years, with women comprising 70.6% of the cohort. For abortive treatment, paracetamol was the most prescribed medication (42%). Regarding prophylactic treatment, adherence was low, with only 30.4% of patients maintaining adherence. Multivariate regression analysis identified the use of antidepressants as an independent predictor of adherence. 83.3% of patients received monotherapy, with antiepileptic drugs being the most prescribed (40%). Notably, polytherapy regimens demonstrated statistically significant superiority in reducing headache duration, MMD, VAS scores, and MIDAS scores (<i>P</i> &lt; 0.001).</p> Conclusion <p>Non-adherence to prophylactic medication is prevalent among individuals with migraine in Egypt. The severity of migraine attacks is lower in patients receiving polytherapy regimens; however, using antidepressants as prophylactic treatment of migraine is positively associated with treatment adherence.</p>