Anti-CGRP Drug Fremanezumab Reduces Severe Hemiplegic Migraine Attacks: Case Series | Research

The takeaway

Fremanezumab reduced the frequency and duration of prolonged hemiplegic migraine attacks in a case series, suggesting anti-CGRP therapy may help this rare, severe migraine subtype.

Rare migraine helped
Anti-CGRP therapy reduced severe hemiplegic migraine attacks — a subtype with very few treatment options

What the researchers found

Fremanezumab reduced the frequency and duration of prolonged sporadic hemiplegic migraine attacks in a case series, with no safety concerns despite theoretical vascular considerations.

Why it matters

Hemiplegic migraine patients are often excluded from anti-CGRP drug trials and guidelines. This evidence supports cautious use in this severe subtype.

How the study worked

Case series of sporadic hemiplegic migraine patients treated with monthly fremanezumab, documenting attack frequency, duration, and safety.

What this study cannot tell us

Case series (lowest evidence level). Small number of patients. No control group. Cannot generalize.

How to read the evidence

Case series — low evidence level but important for a rare condition with no treatment guidelines.

When this study was published

Published in 2025.

The bigger picture

Anti-CGRP drugs may be safe and effective even in migraine subtypes initially considered potential contraindications, broadening their therapeutic scope.

Questions still open

Should hemiplegic migraine remain a relative contraindication for anti-CGRP drugs?
Would other anti-CGRP antibodies show similar benefit?
What is the mechanism of CGRP involvement in hemiplegic migraine specifically?

Common questions

Can anti-CGRP drugs help hemiplegic migraine?

This case series suggests yes — fremanezumab reduced both how often and how long hemiplegic migraine attacks lasted. These attacks cause temporary paralysis and are very difficult to treat.

Why were these drugs not previously used for hemiplegic migraine?

Theoretical concerns about blocking CGRP (a vasodilator) in patients with temporary neurological deficits led to caution. This case series suggests the concern may be unwarranted.

Read the original research

Reduced Frequency of Prolonged Sporadic Hemiplegic Migraine Attacks Following Fremanezumab Treatment-A Case Report.

European journal of neurology, 33(2), e70514

View on PubMed ↗Publisher’s paper ↗

Citation

Hotz, Julian Frederic; Kaindl, Lisa; Krebs, Stefan; Vigl, Marion; Ferrari, Julia; Neumann, Christian; Han, Robert; Ritscher, Lavinia; Sykora, Marek; Gallmetzer, Paolo. (2026). Reduced Frequency of Prolonged Sporadic Hemiplegic Migraine Attacks Following Fremanezumab Treatment-A Case Report.. European journal of neurology, 33(2), e70514. https://doi.org/10.1111/ene.70514