Anti-CGRP antibodies significantly reduced migraine headache days and disability but did not prevent aura episodes, suggesting these are separate biological processes.
p < 0.0001Anti-CGRP antibodies produced highly significant reductions in headache days, medication use, and disability scores — but aura frequency remained unchanged throughout the year.
What the researchers found
Anti-CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab) significantly reduced headache days, migraine-without-aura days, acute medication use, and disability scores (MIDAS and HIT-6) over one year (p < 0.0001). However, these drugs did not reduce the frequency of migraine-with-aura attacks.
Interestingly, while aura episodes kept occurring at the same rate, the headache that normally follows the aura became less intense and shorter — and some patients experienced aura attacks with no headache at all.
The researchers propose that anti-CGRP antibodies work by blocking pain signaling in the trigeminal nerve pathway (a peripheral mechanism) but cannot stop cortical spreading depression — the wave of brain activity that causes the visual and sensory disturbances of aura.
Why it matters
Migraine with aura affects about a third of migraine sufferers, yet most anti-CGRP drug trials have focused on migraine without aura. This study provides early clinical evidence that while these drugs effectively reduce headache pain, they don't prevent aura itself — suggesting aura and headache may be separable processes with different underlying mechanisms.
The numbers in context
n=12 · p<0.0001 for headache days, medication days, MIDAS, HIT-6 · 1-year treatment period
How the study worked
Observational case series of 12 migraine patients treated with anti-CGRP monoclonal antibodies (7 on erenumab, 2 on fremanezumab, 3 on galcanezumab) over 1 year. Data were collected at baseline (3 months prior to treatment) and every 3 months. Outcomes included headache days, migraine days, aura frequency, medication use, MIDAS disability scores, and HIT-6 impact scores.
Who was studied
12 migraine patients with aura, treated with anti-CGRP monoclonal antibodies for 1 year
What this study cannot tell us
Very small sample size (12 patients) without a control group. As an observational case series, it cannot establish causation. The lack of randomization and blinding means placebo effects cannot be ruled out. Results should be considered hypothesis-generating rather than definitive.
How to read the evidence
This is an observational case series with only 12 patients and no control group. While the statistical significance for headache outcomes is strong, the tiny sample size and lack of blinding limit the strength of conclusions, particularly about aura.
When this study was published
Published in 2024, this study uses currently available anti-CGRP medications and reflects contemporary clinical practice. Highly relevant to current migraine treatment decisions.
The bigger picture
Anti-CGRP drugs (like Aimovig, Ajovy, and Emgality) have been game-changers for migraine prevention, but their effect on aura has been poorly studied. This small study adds to growing evidence that aura and migraine headache are driven by different mechanisms — cortical spreading depression for aura vs. trigeminal nerve sensitization for pain. This could guide future drug development targeting aura specifically.
Questions still open
- Would drugs that target cortical spreading depression be more effective at preventing aura than anti-CGRP antibodies?
- Is experiencing aura without subsequent headache a better or worse outcome for patients' quality of life?
- Do larger studies confirm that anti-CGRP drugs have no effect on aura frequency?
Common questions
Do anti-CGRP drugs stop migraine aura?
Why would aura continue even when headaches are treated?
Read the original research
Effect of anti-CGRP-targeted therapy on migraine aura: Results of an observational case series study.
CNS neuroscience & therapeutics, 30(2), e14595
Citation
Cresta, Elena; Bellotti, Alessia; Rinaldi, Giovanni; Corbelli, Ilenia; Sarchielli, Paola. (2024). Effect of anti-CGRP-targeted therapy on migraine aura: Results of an observational case series study.. CNS neuroscience & therapeutics, 30(2), e14595. https://doi.org/10.1111/cns.14595