Over half of migraine patients freely choose to continue CGRP antibodies at 2 years, with 77% resuming after breaks | Research

The takeaway

In 146 migraine patients free to choose their own treatment, CGRP-mAb continuation was 58.8% at 12 months and 51.7% at 24 months, with 76.8% of discontinuers resuming treatment and only 20.7% permanently withdrawing.

77% resume after stopping
When migraine patients freely decide their own treatment, 76.8% who stop CGRP antibodies eventually choose to restart—suggesting clear perceived benefit

What the researchers found

Continuation: 93.2% (3m), 80.2% (6m), 68.9% (9m), 58.8% (12m), 55.4% (18m), 51.7% (24m). Resumption: 76.8%. Permanent withdrawal: 20.7%. HIT-6 and MSQ significantly improved at all points. No predictors of resumption vs withdrawal. 146 patients, patient-directed treatment choice.

Why it matters

When patients control their own treatment decisions—the most realistic scenario—over half continue CGRP drugs at 2 years and >75% who stop eventually return. This is much more optimistic than insurance-mandated persistence data.

How the study worked

Prospective observational study. 146 treatment-naïve migraine patients. Free patient choice to continue/stop/resume. HIT-6 and MSQ assessment. ≥3 month follow-up requirement.

What this study cannot tell us

Single center. 146 patients. Selection of treatment-naïve may bias toward more motivated patients. Japanese population. Insurance coverage may affect access.

How to read the evidence

Prospective observational with unique patient-directed design. Good real-world generalizability.

When this study was published

Published in 2025.

The bigger picture

This challenges the narrative of poor CGRP-mAb persistence from insurance claims data. When patients freely choose, most either stay on treatment or return to it—suggesting the drug's benefit is clearly perceived by patients.

Questions still open

Does patient-directed treatment produce better long-term outcomes than insurer-directed?
Why do patients resume—symptom return or other factors?
Should treatment breaks be planned rather than avoided?

Common questions

How long do people stay on CGRP migraine drugs?

When patients are free to choose, about 59% continue at 1 year and 52% at 2 years. Importantly, of those who stop, over three-quarters eventually restart—meaning the true "rejection rate" is only about 21%. Headache scores remained significantly improved at all time points.

Is it okay to take a break from CGRP antibodies?

This study suggests yes. Many patients stopped temporarily but then chose to restart when migraines returned. The high resumption rate (77%) suggests patients clearly recognize the benefit and feel comfortable resuming when needed, rather than needing uninterrupted treatment.

Read the original research

Continuation, Resumption, and Withdrawal Rates of CGRP-mAb Treatment for Migraine Under Real-World Clinical Conditions in Which Patients Are Free to Choose Own Treatment.

Neurology international, 18(1)

View on PubMed ↗Publisher’s paper ↗

Citation

Tanei, Takafumi; Yamashita, Satoshi; Maesawa, Satoshi; Nishimura, Yusuke; Ishizaki, Tomotaka; Nagashima, Yoshitaka; Suzuki, Takahiro; Hamasaki, Hajime; Yamamoto, Shun; Wakabayashi, Toshihiko; Saito, Ryuta. (2025). Continuation, Resumption, and Withdrawal Rates of CGRP-mAb Treatment for Migraine Under Real-World Clinical Conditions in Which Patients Are Free to Choose Own Treatment.. Neurology international, 18(1). https://doi.org/10.3390/neurolint18010003