A systematic review found limited but concerning evidence that monoclonal antibodies targeting the peptide CGRP for migraine prevention may elevate blood pressure, warranting clinical monitoring.
Only 4 of 693 studies assessed BPDespite widespread use of anti-CGRP antibodies for migraine, very few studies have specifically examined their effect on blood pressure
What the researchers found
From 693 articles screened, only four studies met inclusion criteria for evaluating blood pressure effects of anti-CGRP monoclonal antibodies in migraine patients. Among these, only one study had low risk of bias, and it reported elevated blood pressure following initiation of anti-CGRP(R)-mAb treatment. The extreme scarcity of quality evidence on this cardiovascular safety concern highlights a major gap in the literature despite widespread use of these drugs.
Why it matters
Anti-CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab, eptinezumab) are now prescribed to millions of migraine patients. CGRP is a peptide that dilates blood vessels, so blocking it could logically raise blood pressure. If confirmed, this cardiovascular risk would be especially important for migraine patients, who already have elevated cardiovascular risk compared to the general population.
How the study worked
Systematic review searching PubMed, Cochrane Database, Web of Science, MEDLINE, and EMBASE through May 1, 2024. Inclusion criteria focused on randomized controlled trials and observational cohort or case-control studies examining blood pressure effects of anti-CGRP(R)-mAbs versus controls in migraine patients. Two independent reviewers performed study selection, data extraction, and risk of bias assessment.
What this study cannot tell us
Only four studies met inclusion criteria, severely limiting the strength of conclusions. Most anti-CGRP clinical trials did not specifically assess blood pressure as an endpoint. The review could not perform a meta-analysis due to heterogeneity and limited data. Long-term cardiovascular outcomes beyond blood pressure changes were not assessed. The authors note that the current evidence base is insufficient to draw definitive conclusions.
How to read the evidence
This is a well-conducted systematic review published in Cephalalgia, the leading headache journal. However, the underlying evidence is extremely limited — only four studies met criteria and only one had low risk of bias, making any conclusions preliminary.
When this study was published
Published in 2025 with literature searched through May 2024, this is a current review that captures the state of evidence on an emerging safety concern.
The bigger picture
The CGRP system is one of the most successful peptide-targeted therapeutic areas in medicine. As these drugs move from specialized headache clinics to broader prescribing, understanding their cardiovascular safety profile becomes critical. This review highlights that the field has largely overlooked blood pressure monitoring in clinical trials, a gap that needs urgent attention given CGRP's known vasodilatory role.
Questions still open
- Should blood pressure monitoring become standard of care for all patients starting anti-CGRP migraine therapy?
- Do different anti-CGRP antibodies (targeting the peptide vs. the receptor) have different blood pressure effects?
- Are migraine patients with pre-existing hypertension at higher cardiovascular risk when using anti-CGRP therapies?
Common questions
What is CGRP and why would blocking it affect blood pressure?
Should I stop my CGRP migraine medication if I'm worried about blood pressure?
Read the original research
Impact of CGRP monoclonal antibody treatment on blood pressure in patients with migraine: A systematic review and potential clinical implications.
Cephalalgia : an international journal of headache, 45(1), 3331024241297673
Citation
van der Arend, Britt W H; van Welie, Floor C; Olsen, Michael H; Versijpt, Jan; Van Den Brink, Antoinette Maassen; Terwindt, Gisela M. (2025). Impact of CGRP monoclonal antibody treatment on blood pressure in patients with migraine: A systematic review and potential clinical implications.. Cephalalgia : an international journal of headache, 45(1), 3331024241297673. https://doi.org/10.1177/03331024241297673