Daily Step Count Increases When Anti-CGRP Antibodies Work for Chronic Migraine: A Pilot Study

What the researchers found

In 22 chronic migraine patients who responded to anti-CGRP monoclonal antibody treatment, median daily steps increased significantly from 4,421 to 5,241 (p=0.039) — an 18.5% increase. The increase in daily steps positively correlated with treatment response measured by reduction in monthly migraine days (p=0.013), suggesting that step count could serve as an objective, passively collected marker of treatment effectiveness.

Why it matters

Monitoring migraine treatment response typically relies on patient-reported headache diaries, which are subjective and burdensome. Step count data from smartphones and wearables is automatic and objective. If validated in larger studies, daily step count could become a simple, real-time way for clinicians to track how well anti-CGRP peptide therapies are working — making it easier to identify responders early and adjust treatment.

How the study worked

Pilot study enrolling 22 adults with chronic migraine who were classified as responders to anti-CGRP monoclonal antibody treatment. Average daily steps were compared between the 3 months before and 3 months after treatment initiation using automatically recorded step count data. Correlation between step changes and changes in monthly migraine days was assessed.

What this study cannot tell us

Very small sample size (n=22) with predominantly female participants (20/22). Only treatment responders were included, so the findings don't address whether step count can distinguish responders from non-responders prospectively. Step count data may be influenced by seasonal changes, lifestyle factors, or device-wearing habits. The 3-month comparison window may not capture longer-term activity patterns.

How to read the evidence

This is a small pilot study (n=22) without a control group, including only known treatment responders. While the findings are statistically significant and clinically interesting, the small size and selected population limit generalizability. It provides proof-of-concept requiring validation in larger, prospective studies.

When this study was published

Published in 2024, this study is current and reflects the growing use of both anti-CGRP therapies and digital health monitoring in migraine management.

The bigger picture

Anti-CGRP monoclonal antibodies represent a revolution in migraine treatment — they're the first preventive therapies designed specifically to target the CGRP peptide pathway central to migraine biology. This study adds an innovative angle: using passively collected digital health data to monitor treatment response. As wearable devices become ubiquitous, integrating step count and activity metrics into migraine care could complement traditional diary-based tracking and enable more data-driven treatment decisions.

Questions still open

• Can daily step count prospectively identify responders vs. non-responders to anti-CGRP therapy early in the treatment course?
• Would other wearable metrics like sleep quality, heart rate variability, or activity intensity provide additional insight into migraine treatment response?
• Does the increase in physical activity after anti-CGRP treatment itself contribute to further migraine improvement in a positive feedback loop?

Common questions

Read the original research

Average steps per day as marker of treatment response with anti-CGRP mAbs in adults with chronic migraine: a pilot study.

Scientific reports, 14(1), 18068

Citation

Jantzen, Frederik Thal; Chaudhry, Basit Ali; Younis, Samaira; Nørgaard, Ina; Cullum, Christopher Kjaer; Do, Thien Phu; Beier, Dagmar; Amin, Faisal Mohammad. (2024). Average steps per day as marker of treatment response with anti-CGRP mAbs in adults with chronic migraine: a pilot study.. Scientific reports, 14(1), 18068. https://doi.org/10.1038/s41598-024-68915-5