Anti-CGRP Antibodies Outperform Botox for Resistant Migraine: 43% vs 18% Responder Rate | Research

The takeaway

Anti-CGRP monoclonal antibodies achieved 43% responder rates vs 18% for botulinum toxin A at 6 months in resistant migraine patients, with significantly greater headache day reductions.

43% vs 18%
Anti-CGRP antibodies achieved more than double the ≥50% responder rate of botulinum toxin at 6 months

What the researchers found

≥50% responder rate: anti-CGRP mAbs 43% vs BTX-A 18% (p=0.003). ≥30% responder rate: 54% vs 36% (p=0.06). Significantly greater MHD reduction with anti-CGRP mAbs at 3 months (p=0.015) and 6 months (p=0.022).

Why it matters

Treatment-resistant migraine patients need to know which option works better. This direct comparison provides evidence favoring anti-CGRP antibodies over Botox.

How the study worked

Single-center retrospective cohort with 93 resistant migraine patients (50 anti-CGRP, 43 BTX-A), propensity score matching and IPTW adjustment, 6-month follow-up.

What this study cannot tell us

Single center. Retrospective. Relatively small sample. Cannot determine if results generalize to all anti-CGRP drugs equally.

How to read the evidence

Retrospective comparison with propensity adjustment. Clear superiority signal but needs prospective confirmation.

When this study was published

Published in 2025.

The bigger picture

This real-world comparison strengthens the position of anti-CGRP antibodies as first-line preventive therapy for resistant migraine over botulinum toxin.

Questions still open

Should anti-CGRP antibodies replace BTX-A as first-line for resistant migraine?
Would switching non-responders between these classes improve outcomes?
Are there patient characteristics predicting response to one over the other?

Common questions

Which is better for resistant migraines — CGRP drugs or Botox?

In this study, anti-CGRP antibodies (like erenumab and fremanezumab) worked significantly better: 43% of patients had their headache days cut in half vs only 18% with Botox after 6 months.

Should I switch from Botox to a CGRP drug?

If Botox isn't providing sufficient relief, this evidence supports trying an anti-CGRP antibody. Discuss with your neurologist about switching or potentially combining treatments.

Read the original research

Real-world comparison of treatments with antibodies targeting the CGRP pathway or botulinum toxin type A for resistant migraine.

Revue neurologique, 182(1-2), 59-64

View on PubMed ↗Publisher’s paper ↗

Citation

Gardon, L; Guy, D; Pereira, B; Sickout-Arondo, S; Mongaret, C; Delage, N; Picard, P; Condé, S; Moisset, X. (2026). Real-world comparison of treatments with antibodies targeting the CGRP pathway or botulinum toxin type A for resistant migraine.. Revue neurologique, 182(1-2), 59-64. https://doi.org/10.1016/j.neurol.2025.10.006