All three anti-CGRP monoclonal antibodies (erenumab, galcanezumab, fremanezumab) significantly reduced headache days compared to conventional treatment in chronic migraine patients with medication overuse headache.
P < 0.0001All three anti-CGRP antibodies significantly reduced headache days compared to conventional treatment over 6 months in patients with chronic migraine and medication overuse
What the researchers found
Eighty-eight patients with chronic migraine and medication overuse headache were divided into four groups: erenumab (19.3%), galcanezumab (29.6%), fremanezumab (25%), and conventional medications as control (26.1%). Ages ranged from 18 to 78 years (mean 44.1 ± 13.6), with 65 women and 23 men.
Over 6 months of follow-up, all three anti-CGRP monoclonal antibody groups showed a statistically significant reduction in headache days compared to the conventional treatment control group (P < 0.0001).
Why it matters
Medication overuse headache is one of the most common and challenging complications of chronic migraine, affecting up to half of patients in specialty headache clinics. These results suggest that anti-CGRP antibodies may be particularly effective in this difficult-to-treat population, offering a way to reduce headache burden without the risks of further medication overuse.
How the study worked
This was a randomized, cross-sectional, prospective, open-label trial conducted in a real-world clinical setting. One hundred consecutive patients with chronic migraine and medication overuse headache were enrolled, with 88 completing the study. Patients were divided into four groups receiving erenumab, galcanezumab, fremanezumab, or conventional medications, and followed for 6 months.
What this study cannot tell us
The study had a small sample size with only 17–26 patients per group, limiting statistical power. The open-label design means both patients and clinicians knew which treatment was being given, potentially introducing bias. The study compared different anti-CGRP antibodies against conventional treatment but did not directly compare the antibodies to each other with statistical rigor.
How to read the evidence
This is a small, open-label, real-world study with 88 patients. While it shows significant results, the lack of blinding and small group sizes limit the strength of conclusions. It adds supportive real-world evidence to existing randomized controlled trial data.
When this study was published
Published in 2023, this is recent real-world evidence reflecting current clinical use of anti-CGRP antibodies for chronic migraine with medication overuse headache.
The bigger picture
Anti-CGRP monoclonal antibodies represent a major advance in migraine prevention by targeting the calcitonin gene-related peptide pathway. This study is part of growing real-world evidence that these treatments work not just in clinical trials but in everyday practice, including in the particularly challenging population of patients who overuse acute medications.
Questions still open
- Which of the three anti-CGRP antibodies is most effective specifically for patients with medication overuse headache?
- Do patients need to withdraw from overused medications before starting anti-CGRP treatment, or can the antibodies help without withdrawal?
- How do long-term outcomes beyond 6 months compare between anti-CGRP antibodies and conventional treatments in this population?
Common questions
What is medication overuse headache and how does it relate to CGRP?
Are the three anti-CGRP antibodies equally effective?
Read the original research
Medication Overuse Headache, Chronic Migraine and Monoclonal Antibodies Anti-CGRP: A Real-World Study.
Clinical neuropharmacology, 46(5), 181-185
Citation
Krymchantowski, Abouch; Jevoux, Carla; Krymchantowski, Ana Gabriela; Silva-Néto, Raimundo Pereira. (2023). Medication Overuse Headache, Chronic Migraine and Monoclonal Antibodies Anti-CGRP: A Real-World Study.. Clinical neuropharmacology, 46(5), 181-185. https://doi.org/10.1097/WNF.0000000000000559