Anti-CGRP Drugs Reduce Migraine Days by 1-4 Per Month and Work Even When Other Drugs Fail | Research

The takeaway

Anti-CGRP monoclonal antibodies and the gepant atogepant reduce migraine days by 0.7-3.8 per month and remain effective in patients who failed previous oral prophylactic drugs.

Up to 3.8 fewer migraine days/month
Fremanezumab showed the largest reduction; all anti-CGRP drugs effective even after traditional drug failure

What the researchers found

Anti-CGRP antibodies reduce migraine days by 0.7-3.8/month and atogepant by 0.7-2.4/month, with efficacy maintained in patients refractory to traditional oral prophylactics.

Why it matters

Migraine affects over 1 billion people globally. Anti-CGRP drugs represent the first migraine-specific preventive therapy class and help patients who don't respond to older medications.

How the study worked

Narrative review based on International Headache Society guidelines with additional meta-analyses of anti-CGRP monoclonal antibodies and gepants.

What this study cannot tell us

Efficacy data from clinical trials may not fully reflect real-world effectiveness. Head-to-head comparisons between anti-CGRP agents are limited. Long-term safety data still accumulating. Cost remains a barrier for many patients.

How to read the evidence

Review based on international guidelines and meta-analyses of randomized controlled trials. High-quality evidence.

When this study was published

Published in 2025, reflecting current International Headache Society guidelines.

The bigger picture

The success of anti-CGRP drugs validates decades of neuropeptide research and demonstrates how understanding peptide signaling can lead to transformative treatments.

Questions still open

Which anti-CGRP drug should be tried first?
Can anti-CGRP drugs be combined with traditional prophylactics for refractory migraine?
Are there biomarkers that predict response to anti-CGRP therapy?

Common questions

What are the best migraine prevention drugs available now?

Anti-CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab, eptinezumab) and the oral CGRP blocker atogepant are the newest and most targeted options, reducing migraine days by 1-4 per month with good tolerability.

Will these drugs work if other migraine medications didn't?

Yes — a major advantage of anti-CGRP drugs is that they remain effective in patients who didn't respond to traditional preventive medications like beta-blockers, topiramate, or amitriptyline.

Read the original research

Drugs for Migraine Prophylaxis.

Deutsches Arzteblatt international

View on PubMed ↗Publisher’s paper ↗

Citation

Diener, Hans Christoph; Grans, Julia; Reuter, Uwe. (2026). Drugs for Migraine Prophylaxis.. Deutsches Arzteblatt international. https://doi.org/10.3238/arztebl.m2025.0234