Real-world achievement of higher standards for migraine prevention with CGRP monoclonal antibodies

Cephalalgia. 2026 Jun;46(6):3331024261453284. doi: 10.1177/03331024261453284. Epub 2026 Jun 1.

ABSTRACT

ObjectiveTo evaluate the achievement of the International Headache Society (IHS) higher standards for migraine prevention in patients treated with calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) in real-world practice.MethodsWe retrospectively analyzed 307 migraine patients treated with CGRP mAbs at a single center. Monthly migraine days (MMDs) were assessed at baseline and during follow-up (1-24 months). According to IHS recommendations, migraine control was categorized as optimal (<4 migraine days/month), modest (4-6 days/month), or insufficient (>6 days/month). Patients were further classified by the timing of achieving optimal control.ResultsThe percentage of patients achieving a ≥ 50% reduction in MMDs increased from 36.2% at month 1 to 71.0% at month 24; optimal control increased from 15.0% to 38.8%. Among patients with a ≥ 50% response, 38.7-55.7% achieved optimal control during follow-up. Migraine freedom remained relatively uncommon (1.6-10.1%). Patients who achieved optimal control early (≤3 months) had a lower baseline migraine burden, whereas nonachievers had a higher baseline disease burden and more prior preventive treatment failures.ConclusionsCGRP mAbs were associated with substantial reductions in migraine frequency; however, achieving optimal control and migraine freedom remains challenging in real-world practice, particularly in patients with a higher baseline burden.

PMID:42220267 | DOI:10.1177/03331024261453284