CGRP antagonists (mAbs and gepants) show variable efficacy for cluster headache, with galcanezumab having the strongest evidence but overall results less robust than for migraine.
Less effective than for migraineAnti-CGRP drugs work well for migraine but show less consistent results for cluster headache — different biology may explain this
What the researchers found
CGRP antagonists for cluster headache: galcanezumab has strongest evidence (positive RCT for episodic CH); other agents mixed; safety acceptable but less data than for migraine; efficacy less robust than in migraine.
Why it matters
Cluster headache is the most painful headache disorder with limited preventive options. Anti-CGRP drugs could fill this treatment gap.
How the study worked
Systematic review of CGRP antagonist (mAbs and gepants) safety and efficacy data for cluster headache.
What this study cannot tell us
Limited cluster headache-specific data. Small patient numbers in studies.
How to read the evidence
Systematic review of limited cluster headache data.
When this study was published
Published in 2025.
The bigger picture
CGRP is involved in cluster headache but may play a different role than in migraine, explaining the less consistent drug response.
Questions still open
- Why are anti-CGRP drugs less effective for cluster than migraine headache?
- Would higher doses improve cluster headache response?
- Should galcanezumab be first-line prevention for episodic CH?
Common questions
Do CGRP drugs work for cluster headaches?
Why don't they work as well as for migraines?
Read the original research
Safety and efficacy of calcitonin gene-related peptide antagonists for cluster headache: a systematic review and meta-analysis.
BMC neurology
Citation
Khanfar, Ro'ya; Radwan, Eithar; Hattab, Sama. (2026). Safety and efficacy of calcitonin gene-related peptide antagonists for cluster headache: a systematic review and meta-analysis.. BMC neurology. https://doi.org/10.1186/s12883-026-04733-8