Anti-CGRP Migraine Antibodies Show Benefits in Adolescents With Chronic Headache | Research

The takeaway

In 112 adolescents with chronic headache, CGRP monoclonal antibodies reduced headache frequency by 2 days/month with about 30% perceiving significant benefit, and side effects were similar to adults.

30% benefited
About 30% of adolescents with severe chronic headache (averaging 27 days/month) perceived significant benefit from CGRP antibody treatment — the first data supporting their use in teens

What the researchers found

In 112 adolescents, CGRP mAbs reduced headache frequency by 2.0 days/month (95% CI -0.8 to -3.2). 29.5% perceived significant benefit. 31% reported functional improvement. Side effects were mild and similar to adults. 4.5% discontinued for side effects.

Why it matters

Adolescents with chronic migraine have very limited treatment options and often miss significant school time. This first evidence of CGRP antibody safety and efficacy in teens could expand treatment access for a vulnerable population.

The numbers in context

112 adolescents; mean age 15.9; 26.9 headache days/month baseline; -2.0 days reduction; 29.5% significant benefit; 17% injection site reactions; 4.5% discontinuation

How the study worked

Retrospective multisite cohort study. 112 patients <18 years receiving CGRP mAbs for headache prevention. Demographics, headache characteristics, efficacy, and side effects collected. Mean age 15.9 years. 83.9% chronic migraine.

Who was studied

Adolescents under 18 with chronic refractory headache disorders (83.9% chronic migraine)

What this study cannot tell us

Retrospective study without a control group. Modest average response (2 fewer days/month from a baseline of 27). Only 30% perceived significant benefit. Short follow-up. Self-selected population with highly refractory headache.

How to read the evidence

Low-to-moderate evidence: largest adolescent CGRP antibody cohort published, but retrospective design without control group and modest effect sizes.

When this study was published

Published 2021. Formal clinical trials of CGRP antibodies in pediatric/adolescent populations are now underway.

The bigger picture

This study fills a critical evidence gap for pediatric migraine treatment. As CGRP antibodies become established in adult practice, extending their use to adolescents — with appropriate evidence — addresses an underserved patient population.

Questions still open

Would randomized controlled trials in adolescents confirm this modest benefit?
Can predictors be identified for which adolescents will respond to CGRP antibodies?
Is the lower response rate in adolescents compared to adult trials due to different headache biology or refractory populations?

Common questions

Can teenagers get CGRP antibody injections for migraine?

CGRP antibodies are not yet FDA-approved for patients under 18, but this study of 112 adolescents shows they appear safe with similar side effects to adults. About 30% experienced meaningful improvement. Some pediatric neurologists prescribe them off-label for severe cases.

How well do CGRP antibodies work in teens?

The average improvement was modest — about 2 fewer headache days per month from a baseline of 27 days. However, about 30% of patients reported significant benefit. The relatively low response rate may reflect that these were very severe, treatment-resistant cases.

Read the original research

Calcitonin Gene-Related Peptide Monoclonal Antibody Use for the Preventive Treatment of Refractory Headache Disorders in Adolescents.

Pediatric neurology, 114, 62-67

View on PubMed ↗Publisher’s paper ↗

Citation

Greene, Kaitlin A; Gentile, Carlyn P; Szperka, Christina L; Yonker, Marcy; Gelfand, Amy A; Grimes, Barbara; Irwin, Samantha L. (2021). Calcitonin Gene-Related Peptide Monoclonal Antibody Use for the Preventive Treatment of Refractory Headache Disorders in Adolescents.. Pediatric neurology, 114, 62-67. https://doi.org/10.1016/j.pediatrneurol.2020.09.014