Long-term studies confirm all four CGRP-targeting monoclonal antibodies are safe and effective for preventing episodic migraines, leading to a 2024 AHS recommendation for first-line use over older non-specific preventive therapies.
First-line recommendation2024 American Headache Society consensus now recommends CGRP monoclonal antibodies as first-line preventive treatment for episodic migraine
What the researchers found
Long-term studies published in 2023-2024 confirm ongoing safety and efficacy for all four CGRP-targeting monoclonal antibodies in episodic migraine prevention. These therapies reduce monthly migraine days and increase quality of life while being better tolerated than non-specific migraine preventive therapies (such as beta-blockers, antidepressants, and anticonvulsants).
The accumulated evidence has led to the 2024 American Headache Society (AHS) consensus statement recommending CGRP monoclonal antibodies be considered as first-line preventive treatment in episodic migraine — a significant elevation in their clinical positioning.
Why it matters
For decades, migraine prevention relied on drugs originally developed for other conditions (blood pressure medications, antidepressants, anti-seizure drugs) that often had significant side effects and limited efficacy. CGRP-targeting therapies represent the first migraine-specific preventive treatments, designed to directly block the neuropeptide pathway driving migraine attacks. Their elevation to first-line status by the AHS marks a paradigm shift in headache medicine and validates the peptide-targeted therapeutic approach.
How the study worked
Narrative review of clinical evidence for the safety and efficacy of four CGRP-targeted monoclonal antibodies (erenumab, fremanezumab, galcanezumab, eptinezumab) in episodic migraine prevention, with a focus on recent studies published in 2023-2024.
What this study cannot tell us
This is a narrative review, not a systematic review or meta-analysis. The abstract does not report specific efficacy numbers (e.g., reduction in monthly migraine days) for each antibody. Long-term data typically extend to 1-3 years, and very long-term effects (5+ years) are still accumulating. Cost and access barriers remain significant, as these biologic therapies are expensive. Head-to-head comparisons between the four antibodies are limited.
How to read the evidence
This review summarizes evidence from multiple long-term clinical studies supporting a major medical society consensus recommendation. The underlying evidence includes large randomized controlled trials, making this a strong evidence-based guideline change.
When this study was published
Published in 2025 with focus on 2023-2024 literature, this review is current and reflects the latest evidence supporting the recently elevated clinical positioning of CGRP therapies.
The bigger picture
The CGRP success story is one of the most compelling examples of peptide-targeted drug development translating basic neuroscience into clinical practice. Understanding that the neuropeptide CGRP was a key mediator of migraine led directly to drugs that have transformed millions of patients' lives. The 2024 first-line recommendation reflects the maturation of this drug class and may accelerate broader access through insurance coverage changes. It also validates the broader approach of targeting neuropeptides for neurological disease.
Questions still open
- Are there clinically meaningful differences between the four CGRP monoclonal antibodies in efficacy or tolerability?
- How will the availability of CGRP-targeting therapies affect insurance coverage and patient access compared to cheaper generic preventives?
- Will the first-line recommendation extend to chronic migraine as well, or does the evidence primarily support episodic migraine?
Common questions
What is CGRP and why is it important for migraines?
Can I try a CGRP antibody as my first migraine prevention treatment?
Read the original research
Review: An Update on CGRP Monoclonal Antibodies for the Preventive Treatment of Episodic Migraine.
Current pain and headache reports, 29(1), 55
Citation
Nicol, Kelly S; Burkett, John G. (2025). Review: An Update on CGRP Monoclonal Antibodies for the Preventive Treatment of Episodic Migraine.. Current pain and headache reports, 29(1), 55. https://doi.org/10.1007/s11916-025-01365-4