Anti-CGRP Migraine Antibodies Are Safe and Effective for People with Multiple Sclerosis | Research

The takeaway

Anti-CGRP monoclonal antibodies significantly reduced migraine headache days in MS patients without worsening their MS disease course.

22 → 11.5 headache days/month
Monthly headache days were nearly halved in MS patients treated with anti-CGRP antibodies, with no significant change in their MS disability scores.

What the researchers found

Monthly headache days decreased significantly from 22.0 to 11.5 days (p=0.002) during concurrent treatment with anti-CGRP monoclonal antibodies and MS disease-modifying therapies.

MS disability scores (EDSS) remained stable at 1.9 throughout the study period — from the year before starting anti-CGRP treatment through the last follow-up. Only two patients (8%) experienced a clinical MS relapse and one (4%) showed MRI activity during the treatment period. Mild adverse events occurred in just two patients (8%), and none led to discontinuation of the anti-CGRP therapy.

Why it matters

Migraine is extremely common in MS patients, but doctors have been cautious about combining anti-CGRP migraine drugs with MS immunotherapies due to concerns about drug interactions or worsening MS. This study provides reassuring real-world evidence that the combination is both safe and effective, potentially opening up better migraine management for a large population that suffers disproportionately from both conditions.

How the study worked

This was a retrospective, multicenter study conducted across 14 MS centers. Researchers reviewed records of 25 MS patients who were receiving both anti-CGRP monoclonal antibodies for migraine and stable disease-modifying therapies for their MS. They tracked MS outcomes (relapses, disability scores, MRI activity) and migraine outcomes (monthly headache days, painkiller use) from one year before starting anti-CGRP treatment through the last follow-up visit.

What this study cannot tell us

The study had a small sample size of only 25 patients, which limits statistical power to detect rare adverse events or subtle effects on MS progression. The retrospective design means researchers relied on existing medical records rather than prospective, controlled observation. There was no placebo control group, so the natural fluctuation of both migraine and MS symptoms could influence results. Follow-up duration varied across patients.

How to read the evidence

This is a retrospective, multicenter observational study with 25 patients and no control group. While the multicenter design adds some robustness, the small sample size, lack of randomization, and retrospective nature limit the strength of evidence. The statistically significant migraine improvement is encouraging but needs confirmation in larger prospective trials.

When this study was published

Published in 2025, this study reflects the current standard of care for both MS disease-modifying therapies and anti-CGRP migraine treatments. The findings are timely and clinically relevant.

The bigger picture

CGRP (calcitonin gene-related peptide) has become one of the most successful therapeutic targets in modern headache medicine. Anti-CGRP antibodies like erenumab, fremanezumab, and galcanezumab have transformed migraine prevention. This study extends their evidence base into a complex patient population — people with autoimmune neurological disease who are already on immunomodulating drugs — and helps clarify that targeting CGRP doesn't disrupt the immune pathways relevant to MS.

Questions still open

Would the safety and effectiveness profile hold in a larger, prospective trial with longer follow-up?
Does the type of MS disease-modifying therapy (mAb vs. non-mAb) affect how well anti-CGRP antibodies work for migraine in these patients?
Could anti-CGRP treatment have any subtle long-term effects on MS immune pathology that this short study couldn't detect?

Common questions

Can people with MS safely take anti-CGRP migraine drugs?

This study suggests yes — 25 MS patients took anti-CGRP antibodies alongside their MS medications with no significant worsening of MS symptoms. Mild side effects occurred in only 8% of patients. However, the small sample size means larger studies are needed to fully confirm safety.

What is CGRP and why is it targeted for migraine treatment?

CGRP (calcitonin gene-related peptide) is a protein involved in pain signaling and blood vessel dilation in the brain. During migraines, CGRP levels rise significantly. Anti-CGRP monoclonal antibodies block this peptide, preventing it from triggering the cascade of events that leads to migraine attacks.

Read the original research

Effectiveness, safety, and impact on multiple sclerosis course of anti-CGRP monoclonal antibodies.

Journal of the neurological sciences, 469, 123392

View on PubMed ↗Publisher’s paper ↗

Citation

Nociti, Viviana; Romozzi, Marina; Annovazzi, Pietro; Fantozzi, Roberta; Tortorella, Carla; Vercellino, Marco; Iannone, Luigi Francesco; De Luca, Giovanna; Tomassini, Valentina; Di Filippo, Massimiliano; Lorefice, Lorena; Maniscalco, Giorgia Teresa; Paolicelli, Damiano; Pinardi, Federica; Ronzoni, Marco; Solaro, Claudio Marcello; Gasperini, Claudio; Calabresi, Paolo; Vollono, Catello; Cocco, Eleonora. (2025). Effectiveness, safety, and impact on multiple sclerosis course of anti-CGRP monoclonal antibodies.. Journal of the neurological sciences, 469, 123392. https://doi.org/10.1016/j.jns.2025.123392