Anti-CGRP medications showed effectiveness in managing intractable chronic daily headache that had not responded to other preventive treatments, offering hope for the most refractory patients.
Last-line successAnti-CGRP drugs worked in patients with chronic daily headache that had failed multiple other preventive treatments
What the researchers found
Anti-CGRP medications effectively reduced headache frequency and severity in patients with intractable chronic daily headache refractory to other preventive treatments.
Why it matters
Patients with intractable CDH suffer daily and have exhausted standard treatments. Anti-CGRP drugs offer a lifeline by targeting a different pathway than previous failed therapies.
The numbers in context
All consecutive patients under 18 years at a single center. All had failed multiple daily preventive medications.
How the study worked
Clinical evaluation of anti-CGRP medications (mAbs and gepants) in patients with intractable CDH who failed multiple prior preventive therapies.
Who was studied
Pediatric patients (<18 years) with intractable chronic daily headaches at a single center
What this study cannot tell us
Intractable CDH is heterogeneous. Response rates may be lower than in less refractory populations. Lack of placebo control in refractory settings. Small sample sizes typical for treatment-resistant populations.
How to read the evidence
Moderate evidence: clinical evaluation in a refractory population where controlled trials are difficult to conduct.
When this study was published
Published in 2025. Extends anti-CGRP evidence to the most treatment-resistant headache patients.
The bigger picture
CGRP-targeting drugs are increasingly positioned as the best option for the hardest-to-treat headache patients. Moving from episodic migraine to chronic migraine to intractable CDH, the evidence supports CGRP drugs across the entire severity spectrum.
Questions still open
- Which anti-CGRP drug is most effective for the most refractory CDH patients?
- Should anti-CGRP drugs be tried earlier in CDH before other preventives fail?
- Can combining anti-CGRP mAbs with gepants provide additional benefit in refractory CDH?
Common questions
What options are left when headache treatments fail?
Are anti-CGRP drugs stronger than other headache treatments?
Read the original research
The Use of Anti-CGRP Medications for Management of Intractable Chronic Daily Headaches in the Pediatric Population: Case Series and Literature Review.
Journal of child neurology, 8830738251374537
Citation
Akbar, Asra; Deshpande, Girish; Tripathi, Sandeep. (2025). The Use of Anti-CGRP Medications for Management of Intractable Chronic Daily Headaches in the Pediatric Population: Case Series and Literature Review.. Journal of child neurology, 8830738251374537. https://doi.org/10.1177/08830738251374537