A network meta-analysis of 80 studies found CGRP receptor antagonists scored highest for reducing monthly migraine days (p-score 0.71), while triptans were most effective for acute pain, photophobia, and nausea relief.
CGRP antagonists rank #1Highest p-score (0.71) for reducing monthly migraine days in network meta-analysis of 80 studies comparing all migraine drug classes
What the researchers found
CGRP antagonists: highest p-score (0.71) for reducing monthly migraine days, SMD -0.38 vs placebo. CGRP mAbs: SMD -0.35 vs placebo. Triptans: most effective for acute pain, photophobia, phonophobia, nausea. Both active classes had increased adverse events.
Why it matters
Migraine treatments now include multiple drug classes targeting different mechanisms. This analysis provides the first comprehensive ranking across both preventive and acute outcomes, helping clinicians make evidence-based treatment selections.
How the study worked
Frequentist network meta-analysis of 80 studies from three databases through April 2023. Six outcomes assessed. Random-effects model when I²>30%, fixed-effect when ≤30%. P-scores for ranking.
What this study cannot tell us
Literature search limited to April 2023. Newer agents may not be fully represented. Heterogeneity across outcomes. Adverse event comparison across drug classes is complex due to different mechanisms and administration routes.
How to read the evidence
Network meta-analysis of 80 studies—high-quality evidence synthesis. Strong methodology with appropriate model selection and sensitivity analyses.
When this study was published
Published in 2025; literature through April 2023. Some newer CGRP agents may have additional data not captured.
The bigger picture
CGRP-targeting peptide drugs have transformed migraine prevention. This meta-analysis confirms their superiority for reducing migraine frequency while showing triptans remain essential for acute attacks, supporting a combination prevention + acute treatment approach.
Questions still open
- Should CGRP drugs be first-line for chronic migraine prevention?
- How do newer CGRP antagonists (atogepant, rimegepant) compare in updated analyses?
- Can combining CGRP prevention with triptan acute therapy improve outcomes?
Common questions
What are CGRP drugs for migraine?
Are CGRP drugs better than triptans?
Read the original research
Network meta-analysis of migraine therapies: balancing efficacy and safety.
Brain research, 1867, 149946
Citation
Sharma, Rajat; Pandey, Ayush; Agarwal, Rachna; Tripathi, Shashank. (2025). Network meta-analysis of migraine therapies: balancing efficacy and safety.. Brain research, 1867, 149946. https://doi.org/10.1016/j.brainres.2025.149946