Anti-CGRP monoclonal antibodies and onabotulinumtoxinA provide clinically meaningful migraine prevention within the first week of treatment, with some showing benefits as early as Day 1.
>50% reduction on Day 1Eptinezumab reduced migraine attack likelihood by more than half on the first day of treatment compared to baseline.
What the researchers found
All five approved migraine preventive treatments demonstrated clinically relevant benefits during the first treatment week:
- Erenumab reduced weekly migraine days within 1 week (3 studies)
- Fremanezumab increased headache-free days starting Day 1 and significantly reduced migraine frequency within 1 week (6 studies)
- Galcanezumab significantly reduced the number of patients experiencing migraine beginning Day 1 and through the first week (3 studies)
- Eptinezumab reduced migraine attack likelihood on Day 1 by more than 50% versus baseline (4 studies)
- OnabotulinumtoxinA reduced headache and migraine days within 1 week (2 studies)
Four publications also reported improvements in function, disability, and quality of life as early as Week 4. No publications on traditional oral preventive agents met the criteria for early-onset prevention.
Why it matters
Migraine patients often endure weeks or months waiting for traditional preventive medications to take effect, during which they continue to suffer attacks and may lose faith in treatment. Demonstrating that newer peptide-targeted therapies work within days rather than weeks supports earlier adoption of these treatments and could improve patient adherence and quality of life.
How the study worked
This was an evidence-based scoping literature review searching PubMed, EMBASE, and CINAHL for clinical trial publications between 1988 and 2020. The review focused on approved migraine preventive treatments demonstrating benefits within 30 days of administration. A total of 16 publications describing 18 studies were identified and analyzed.
What this study cannot tell us
The review only identified studies on five approved treatments; no publications on traditional oral preventives met the inclusion criteria, making direct comparison impossible. Cost-benefit analyses were absent from all included studies. The scoping review methodology is less rigorous than a systematic review. The search was limited to publications through 2020, missing more recent data.
How to read the evidence
This is a scoping literature review synthesizing 18 clinical trials. While it draws on randomized controlled trial data, it is not itself a systematic review or meta-analysis, and its conclusions are limited by the scope and methodology of the included studies.
When this study was published
Published in 2022 with literature through 2020. The anti-CGRP antibody landscape has continued to evolve, but the early-onset findings remain relevant to current clinical practice.
The bigger picture
Anti-CGRP monoclonal antibodies represent a paradigm shift in migraine treatment — the first class designed specifically to target migraine biology. This review highlights that these peptide-based therapies not only work but work fast, which is a significant advantage over traditional preventives like topiramate or propranolol that can take 2–3 months to show full effect. The rapid onset also has implications for clinical trial design and real-world treatment expectations.
Questions still open
- Does the rapid onset of CGRP-targeted therapies translate to better long-term treatment adherence compared to slower-acting oral preventives?
- What is the cost-effectiveness of early-onset migraine prevention with anti-CGRP antibodies compared to traditional oral therapies?
- Could early intervention with CGRP-targeted therapies prevent the progression from episodic to chronic migraine?
Common questions
How fast do anti-CGRP migraine drugs start working?
Do traditional migraine preventives work as quickly?
Read the original research
The importance of an early onset of migraine prevention: an evidence-based, hypothesis-driven scoping literature review.
Therapeutic advances in neurological disorders, 15, 17562864221095902
Citation
Gottschalk, Christopher; Buse, Dawn C; Marmura, Michael J; Torphy, Bradley; Pavlovic, Jelena M; Dumas, Paula K; Lalvani, Nim; Blumenfeld, Andrew. (2022). The importance of an early onset of migraine prevention: an evidence-based, hypothesis-driven scoping literature review.. Therapeutic advances in neurological disorders, 15, 17562864221095902. https://doi.org/10.1177/17562864221095902