Background: As the second leading cause of years lived with disability in the world, and the first in people under 50, migraine represents a major burden to healthcare systems. This study examined treatment patterns and healthcare resource utilization (HRU) in patients with migraine using real-world data from Alberta. Methods: This was a retrospective cohort study of patients with ≥1 ICD-9-CM/ICD-10-CA code for migraine or ≥1 prescription for a triptan from April 1st, 2012 to March 31st, 2018. Descriptive statistics were used to characterize the study outcomes. Results: The incidence of migraine exceeded 1,000 cases per 100,000 person-years over the study period. The mean age of the cohort (n=199,931) was 40.0, and 72.3% were women. Migraine-related HRU accounted for 3%-10% of all HRU across endpoints (e.g., ED visits, hospitalization, physician visits). One-third of the cohort were prescribed acute medications (non-steroidal anti-inflammatories, triptans or other (including opioids)), whereas fewer than one-fifth were prescribed at least one migraine preventive such as tricyclic anti-depressants (proportion: 15%), anti-convulsants (13%), beta-blockers (7%), or neurotoxins (4%). Conclusions: The low medication prescription rates and high HRU indicates the potential unmet need and high disability in patients with migraine. The impact of migraine treatment patterns on HRU is an avenue for future research.