Real-world achievement of higher standards for migraine prevention with CGRP monoclonal antibodies

2026-06-01

PRE

Keisuke Suzuki

Shiho Suzuki

Saro Kobayashi

Mukuto Shioda

Hiroaki Fujita

Yasuo Haruyama

Ryotaro Hida

Koichi Hirata

DOI：10.1177/03331024261453284

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Objective To evaluate the achievement of the International Headache Society (IHS) higher standards for migraine prevention in patients treated with calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) in real-world practice. Methods We retrospectively analyzed 307 migraine patients treated with CGRP mAbs at a single center. Monthly migraine days (MMDs) were assessed at baseline and during follow-up (1–24 months). According to IHS recommendations, migraine control was categorized as optimal (<4 migraine days/month), modest (4–6 days/month), or insufficient (>6 days/month). Patients were further classified by the timing of achieving optimal control. Results The percentage of patients achieving a ≥ 50% reduction in MMDs increased from 36.2% at month 1 to 71.0% at month 24; optimal control increased from 15.0% to 38.8%. Among patients with a ≥ 50% response, 38.7–55.7% achieved optimal control during follow-up. Migraine freedom remained relatively uncommon (1.6–10.1%). Patients who achieved optimal control early (≤3 months) had a lower baseline migraine burden, whereas nonachievers had a higher baseline disease burden and more prior preventive treatment failures. Conclusions CGRP mAbs were associated with substantial reductions in migraine frequency; however, achieving optimal control and migraine freedom remains challenging in real-world practice, particularly in patients with a higher baseline burden.

Real-world achievement of higher standards for migraine prevention with CGRP monoclonal antibodies

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