Anti-CGRP monoclonal antibodies significantly reduced aura days and migraine disability in patients with hemiplegic migraine, though headache day reductions did not reach statistical significance.
83% response rateTen of 13 hemiplegic migraine patients achieved greater than 50% reduction in both monthly headache days and aura frequency with anti-CGRP antibody treatment.
What the researchers found
In a pooled analysis of 13 hemiplegic migraine patients treated with anti-CGRP monoclonal antibodies, median monthly aura days dropped from 3 to 0.6 (p=0.018) and MIDAS disability scores fell from 88 to 28 (p=0.018) at three months.
Monthly headache days decreased numerically from 18 to 9, though this did not reach statistical significance (p=0.077). Notably, 83% of patients achieved greater than 50% reduction in both headache days and aura frequency, and 75% saw more than 50% improvement in disability scores. No adverse events were reported across the entire cohort.
Why it matters
Hemiplegic migraine patients are systematically excluded from randomized controlled trials, leaving clinicians with almost no evidence-based treatment options. This analysis provides the first pooled evidence that anti-CGRP antibodies — already proven effective for other migraine types — may also work for this rare and highly disabling condition, potentially opening a new treatment avenue for an underserved patient population.
How the study worked
The researchers conducted a systematic review following PRISMA guidelines, searching PubMed, Scopus, and Web of Science for any studies reporting hemiplegic migraine patients treated with anti-CGRP antibodies. They extracted individual patient data from the six qualifying studies (four case series and two case reports) and performed pooled analyses comparing outcomes at baseline versus three months of treatment.
What this study cannot tell us
The analysis included only 13 patients from six small studies (case series and case reports), with no randomized controlled data. The overall evidence certainty was rated very low by GRADE assessment. Without a control group, it's impossible to separate treatment effects from natural disease fluctuation or placebo response. The three-month follow-up is also relatively short for evaluating long-term effectiveness and safety.
How to read the evidence
Evidence certainty is very low due to the small sample size (13 patients), lack of randomized controlled trials, and reliance on case series and case reports. While the results are promising, they need confirmation in prospective multicenter studies.
When this study was published
Published in 2026, this is the most current pooled analysis of anti-CGRP antibody use in hemiplegic migraine and reflects the latest available evidence for this rare condition.
The bigger picture
Anti-CGRP monoclonal antibodies have transformed migraine prevention for common migraine subtypes. This study extends that evidence to hemiplegic migraine — a condition that has been a therapeutic orphan due to its rarity. If confirmed in larger prospective studies, these findings could reshape treatment guidelines for rare migraine subtypes and support broader labeling of anti-CGRP therapies.
Questions still open
- Would anti-CGRP antibodies show similar benefits in a larger, randomized controlled trial of hemiplegic migraine patients?
- Why did aura days and disability scores improve significantly while headache day reduction did not reach statistical significance?
- Are there differences in effectiveness among the various anti-CGRP antibodies (erenumab, fremanezumab, galcanezumab) specifically for hemiplegic migraine?
Common questions
What is hemiplegic migraine and why is it so hard to treat?
What are anti-CGRP monoclonal antibodies and how do they work?
Read the original research
Effectiveness and safety of anti-CGRP monoclonal antibodies in hemiplegic migraine: an individual patient quantitative analysis.
The journal of headache and pain, 27(1)
Citation
Romozzi, Marina; Palermo, Matteo; Danno, Daisuke; Katsuki, Masahito; Tosto, Federico; Signorelli, Francesco; Vollono, Catello; Matsumori, Yasuhiko; Calabresi, Paolo; Ornello, Raffaele; Iannone, Luigi Francesco. (2026). Effectiveness and safety of anti-CGRP monoclonal antibodies in hemiplegic migraine: an individual patient quantitative analysis.. The journal of headache and pain, 27(1). https://doi.org/10.1186/s10194-026-02283-5