Aimovig (erenumab-aooe) / Amgen, Novartis - LARVOL DELTA

Comparison of functional responses to CGRP and related peptides in human middle meningeal and superficial temporal arteries (EHF-EHC 2025) - "Our aim was to compare the vasodilatory responses of extracranial human superficial temporal arteries (HSTA) and intracranial middle meningeal arteries (HMMA) to CGRP, the amylin analogue pramlintide, and adrenomedullin 2 (AM2), as well as the inhibition induced by the CGRP receptor-binding monoclonal antibody erenumab and the CGRP receptor antagonist olcegepant. Similar CGRP inhibition in both arteries may contribute to the antimigraine effects of CGRP receptor-targeting medications at either location. Finally, these results may also suggest that pain pathways relevant to migraine may overlap with those implicated in temporomandibular disorders."

CNS Disorders • Giant Cell Arteritis • Migraine • Musculoskeletal Diseases • ADM

Epigenetics in migraine: the junior editorial board members' vision. (PubMed, J Headache Pain) - "The role of epigenetic modifications of genes involved in the CGRP pathway, synaptic plasticity and TRPV1, TRPA1 and estrogen receptor signaling in migraine is emerging. Therefore, a deeper understanding of the impact of epigenetics in migraine pathophysiology and neuropharmacology is needed to revert chronification and personalize medicine in the field of migraine, improving efficacy and safety of treatments and widening the therapeutic armamentarium."

Journal • Review • CNS Disorders • Migraine • Pain • Pediatrics • ANK1 • ER • TRPA1 • TRPV1

Prescription of Monoclonal Antibodies Against Calcitonin Gene-Related Peptide for the Prophylaxis of Migraine in Austria: A Retrospective, Longitudinal Analysis of Nationwide Insurance Data. (PubMed, Eur J Neurol) - "In this nationwide study persistence with CGRP-mAbs was excellent; dispensations of triptans and other preventatives decreased during CGRP-mAb therapy. Therapy breaks were common, but the majority resumed CGRP-mAbs, which indicates the need for long-term prophylaxis."

Journal • Reimbursement • Retrospective data • US reimbursement • CNS Disorders • Migraine • Pain

MIGRA-MS: A case series on chronic migraine and multiple sclerosis (EHF-EHC 2025) - "Prior treatments included interferons and glatiramer acetate; current therapies consisted of ocrelizumab, natalizumab, alemtuzumab, teriflunomide, or dimethyl fumarate...All received a median of three classic preventives (amitriptyline in all cases) and onabotulinumtoxinA (PREEMPT, 155 IU) with only one responder; two patients received an extended dose (195 IU) without benefit and later CGRP monoclonal antibodies (galcanezumab, erenumab, eptinezumab) with no response, and atogepant with only transient or partial benefit...In this case series of relapsing–remitting MS with chronic resistant migraine, response to onabotulinumtoxinA and anti-CGRP therapies was limited, with no drug interactions or adverse effects observed. An individualized approach and further studies are needed to assess emerging treatments in this subgroup."

Clinical • CNS Disorders • Migraine • Multiple Sclerosis • Pain

Is there an association between the effectiveness of anti-CGRP monoclonal antibodies in migraine and injection site reactions? (EHF-EHC 2025) - "The cohort included patients receiving erenumab (24.8%), galcanezumab (27.8%) and fremanezumab (47.4%). However, our findings suggest that the presence of these reactions does not compromise the clinical efficacy of the treatment. While ISRs may cause patient discomfort, they do not appear to influence therapeutic outcomes."

CNS Disorders • Dermatology • Migraine • Pain

Effectiveness and tolerability of anti-CGRP monoclonal antibodies for the prevention of migraine in pediatric patients in real world (EHF-EHC 2025) - "Types of mAbs: erenumab 140 mg (50.0%), fremanezumab 125 mg (30.0%), galcanezumab 120 mg (20.0%). Anti-CGRP mAbs in adolescents with resistant migraine in real world are well tolerated, with effectiveness similar to that observed in the adult population during the first 3 months of treatment. Our data support the use of anti-CGRP mAbs as a therapeutic option in the pediatric population."

Clinical • Real-world • Real-world evidence • CNS Disorders • Migraine • Pain • Pediatrics

Long-term efficacy and predictors of response of cgrp monoclonal antibodies in migraine prevention: A real-world service evaluation (EHF-EHC 2025) - "Most first received fremanezumab ( n =157, 70%) or erenumab ( n =65, 29%); one received galcanezumab. Response is more likely in triptan responders and those starting later. Poorer outcomes with longer migraine duration, more premonitory symptoms, and prior failure of preventives support early initiation of mAbs for a better outcome."

Clinical • Real-world • Real-world evidence • CNS Disorders • Migraine • Pain

People with migraine and two years treatment with anti-CGRP therapies. First results from the prospective national registry "Hercules" (EHF-EHC 2025) - "So far, 322 subjects with migraine and prior failure to at least 3 repurposed anti-migraine prophylactic treatments attending 7 headache centers in Greece have been recorded, of whom 141 (43.7%) completed the 2-year treatment with anti-CGRP agents [17/141 (12%) subjects with erenumab; 18/141 (12.7%) with galcanezumab; and 106/141 (75.2%) with fremanezumab] while 51/322 (15.8%) participants discontinued treatment [fremanezumab 26/322 (8%); galcanezumab 17/322 (5.3%); 7/322 (2.2%) erenumab; eptinezumab 1/322 (0.3%)], due to failure [40/322 (12.4%)], adverse events (AE) [9/322 (2.8%)], or complete remission of migraine [2/51 (0.6%)]. More than 75% or 100% reduction in MMDs were recorderd in 38/141 (26.9%) and 9/141 (6.4%) subjects. Anti-CGRP mAbs are effective, safe, and well tolerated after long-term administration and should be considered as a first-line prophylactic treatment for migraine."

Clinical • CNS Disorders • Constipation • Gastroenterology • Gastrointestinal Disorder • Migraine • Pain

Four‑year real‑world efficacy and tolerability of anti‑CGRP therapies in a tertiary headache centre in England (EHF-EHC 2025) - "A total of 548 treatments were initiated in 415 patients (rimegepant: n=57; atogepant: n=60; erenumab: n=283; fremanezumab: n=136; galcanezumab: n=12). Atogepant was associated with the most adverse effects, with constipation, dizziness, and "brain fog" reported. Fremanezumab was associated with a higher treatment success rate than erenumab, rimegepant, and atogepant in our cohort."

Clinical • Real-world • Real-world effectiveness • Real-world evidence • CNS Disorders • Constipation • Gastroenterology • Gastrointestinal Disorder • Migraine • Pain

Satisfaction rates and self-reported adverse events of antiCGRP therapies for migraine prevention – Focus on patient perspectives (EHF-EHC 2025) - "4% of questionnaires corresponded to patients on Atogepant, 9.3% on Erenumab , 24.4% on Eptinezumab, 29% on Galcanezumab and 32% on Fremanezumab. Most frequent, were gastrointestinal symptoms and local skin reactions. Nevertheless, some other complaints were not expected such as weight gain, dizziness, palpitations and chest pain arising in more than 10% of patients, showing the need for maintaning recent therapies adverse events surveillance"

Adverse events • Clinical • Cardiovascular • CNS Disorders • Hypertension • Migraine • Pain

Chronology of response to Anti-CGRP mAbs in migraine: The CRONOS-CGRP study (EHF-EHC 2025) - "We conducted a single-center prospective cohort study including 462 patients with episodic or chronic migraine treated with erenumab, galcanezumab, or fremanezumab between February 2021 and November 2024. Switching may be most beneficial around month 4 in non-responders. Baseline clinical features may help predict early response."

CNS Disorders • Migraine • Pain

Clinical characteristics and treatment outcomes in resistant and refractory migraine: Application of the European Headache Federation (EHF) 2020 criteria in a UK tertiary headache cohort (EHF-EHC 2025) - "Galcanezumab looked to be significantly less effective compared with Erenumab (p=0.02). RM accounted more than one-quarter of our patients with a high proportion of migraine aura, depression, high BMI. Older rM patients seem to respond better to Erenumab compared to ligand antiCGRP."

Clinical • CNS Disorders • Depression • Migraine • Mood Disorders • Pain

Local cutaneous complications of CGRP monoclonal antibodies: A case series (EHF-EHC 2025) - "Nine women treated with subcutaneous anti-CGRP monoclonal antibodies developed mild/moderate local cutaneous reactions (mainly erythema, induration, edema, and pruritus) representing 5% of all treated patients (n=190; fremanezumab 88, galcanezumab 75, erenumab 27)...Two continued therapy with supportive measures (local cooling, topical corticosteroid cream, pre/post-injection antihistamines, and rotation of injection site to abdominal area), while five required switching due to persistent reactions with or without lack of efficacy: two to atogepant, one to erenumab then eptinezumab, and one directly to eptinezumab; one discontinued...Supportive measures allowed continuation in some cases, but most required switching to another monoclonal antibody or a gepant. Monitoring and proactive management are essential to minimize treatment discontinuation."

Clinical • CNS Disorders • Dermatology • Immunology • Migraine • Pruritus

Long-term effectiveness of monoclonal antibodies targeting CGRP in migraine patients (EHF-EHC 2025) - "We aim to evaluate the effectiveness of 3 anti-CGRP subcutaneous monoclonal treatments (erenumab, galcanezumab and fremanezumab) over 2 to 3 years. Monoclonal antibodies showed a remarkable decrease in the frequency of headaches and migraine, as well as the score in MIDAS and HIT-6 scales, not being influenced by the mentioned confusion factors. This improvement is more noticeable during the first 6 months of treatment, but is stable over time until 36 months."

Clinical • Cardiovascular • CNS Disorders • Fibromyalgia • Inflammation • Migraine • Musculoskeletal Pain • Pain • Rheumatology

CGRP, VIP and PACAP plasmatic levels in migraine patients before and after anti-CGRP(R) monoclonal antibodies prophylaxis (EHF-EHC 2025) - "From Feb 2022 to Feb 2023, we enrolled 56 migraineurs who began prophylaxis with erenumab (n=26), galcanezumab (n=16), or fremanezumab (n=14). VIP and PACAP levels remained unaffected by treatment. Further studies are needed to clarify their interplay with CGRP in migraine pathogenesis."

Clinical • CNS Disorders • Migraine • Pain • ADCYAP1

Does Fibromyalgia improve with CGRP targeting therapy? (EHF-EHC 2025) - "The most commonly used CGRP monoclonal antibody was fremanezumab (63%), followed by erenumab (30%) and galcanezumab (7%). Our study showed that a minority of patients with migraine and fibromyalgia will experience improvement in their fibromyalgia symptoms with CGRP mAbs. This may suggest the underlying biology of fibromyalgia in patients with migraine is largely driven by mechanisms other than CGRP."

CNS Disorders • Fibromyalgia • Migraine • Musculoskeletal Pain • Otorhinolaryngology • Pain • Rheumatology • Vertigo

Eptinezumab for migraine prevention: Initial experience from a Portuguese tertiary hospital (EHF-EHC 2025) - "Prior anti-CGRP monoclonal antibody use was documented in 14 patients (78%), all of whom had previously received galcanezumab. Among them, 4 were also treated with fremanezumab, and 1 of these had additionally received erenumab...Nonetheless, in this cohort, it was not frequently selected as a first-line option, being primarily used in patients with highly refractory migraine. Treatment adherence was high and further data are needed to assess long-term effectiveness and better define its role in clinical practice."

Clinical • CNS Disorders • Migraine • Pain

Assessing the effectiveness of personalized migraine treatment – A 22-year N-of-1 study (EHF-EHC 2025) - "No significant adverse effects were reported Topiramate (2006) was ineffective (+8.3% headache days); amitriptyline (2008) increased headache days (+20.4%) but reduced zolmitriptan use (−37.7%)...Erenumab (2020–2021) worsened both metrics (+4.1%, +37.8%). Flunarizine (2023) had modest benefit (−17%), and oxitriptan (2023–2024) had minimal effect. Despite long-term triptan overuse, the patient never developed medication-overuse headache, and zolmitriptan remained effective throughout We report a case of chronic refractory migraine with long-term triptan overuse but without evidence of medication-overuse headache. This case raises the question of whether pharmacological resistance to preventives may be linked to preserved responsiveness to acute treatments"

CNS Disorders • Migraine • Mood Disorders • Obsessive-Compulsive Disorder • Pain • Personality Disorder

Reporting of lack of efficacy of anti-CGRP monoclonal antibodies in migraine patients treated with other concomitant monoclonal antibodies: A VigiBase disproportionality analysis (EHF-EHC 2025) - "Reports listing erenumab, galcanezumab, fremanezumab, or eptinezumab as suspected or interacting drugs and collected in VigiBase up to March 9th, 2025 were included and classified as cases (reporting lack of efficacy) or non-cases (reporting other adverse drug reactions). The concomitant use of other mAbs in patients receiving anti-CGRP mAbs for migraine is not associated with increased reporting of lack of efficacy in VigiBase. These findings offer preliminary reassurance regarding the real-world effectiveness of anti-CGRP mAbs when administered in combinations with mAbs for other indications."

Clinical • CNS Disorders • Migraine • Pain

Comparative effects of anti-CGRP monoclonal antibodies and atogepant on migraine disability, sleep quality, and attack frequency: A 12-month observational study (EHF-EHC 2025) - "This retrospective observational study included patients with chronic migraine refractory to first-line preventives, treated with erenumab, galcanezumab, fremanezumab, or atogepant. Atogepant showed promising early improvements in sleep in selected patients. These findings support multidimensional monitoring—including disability and sleep quality—in migraine care."

Clinical • Observational data • CNS Disorders • Migraine • Pain • Sleep Disorder

Efficacy and adverse effects of anti-calcitonin gene-realted peptide monoclonal antibodies: A retrospective analysis (EHF-EHC 2025) - "The study included 148 patients who were treated with fremanezumab or erenumab at LSMUH Kaunas Clinics in 2024. Both anti-CGRP mAbs are proven to be effective and safe drugs for the prophylaxis of migraine. Fremenezumab showed better results than erenumab, however, more equal distribution of patients is needed to make our findings more accurate."

Adverse events • Retrospective data • Alopecia • Cardiovascular • CNS Disorders • Constipation • Gastroenterology • Gastrointestinal Disorder • Migraine

Combining anti-CGRP antibodies with atogepant: Safety and efficacy in a patient cohort (EHF-EHC 2025) - "Treatments included erenumab (n=1), fremanezumab (n=11), galcanezumab (n=6), and eptinezumab (n=9). No serious adverse events were reported. In this real-world cohort, combining anti-CGRP mAbs with atogepant appears to be safe and may offer additional benefit."

Clinical • CNS Disorders • Constipation • Gastroenterology • Gastrointestinal Disorder • Insomnia • Migraine • Sleep Disorder

Use of eptinezumab or an alternative subcutaneous CGRP-targeting monoclonal antibody after non-response to two prior CGRP targeting treatments: A real-world observational evaluation (EHF-EHC 2025) - "We identified 43 patients who had received a third CGRP-MAb after non-response to 2 prior CGRP targeting treatments; 22 received a third SC MAb (11 galcanezumab, 10 fremanezumab and 1 erenumab) and 21 received eptinezumab. Use of a third SC MAb did not result in a significant reduction in HDs/SHDs, with lower overall positive response rates. Our evaluation is limited by its uncontrolled, observational nature."

Clinical • Real-world • Real-world evidence • CNS Disorders • Migraine

Efficacy and safety of combination of anti-CGRP monoclonal antibodies and onabotulinumtoxinA in chronic migraine treatment: A systematic review and meta-analysis (EHF-EHC 2025) - "Erenumab + onabotulinumtoxinA showed significant reductions in MHD (-5.53 days; 95% CI: -7.76, -3.30; p <0.00001, low certainty) and MMD (-4.42 days; 95% CI: -6,28, -2.56; p <0.00001, low certainty) compared to onabotulinumtoxinA alone. Galcanezumab + onabotulinumtoxinA yielded borderline significant MHD reduction (-5.30 days; 95% CI: -10.54, -0.06; p=0.05, low certainty) compared to onabotulinumtoxinA alone...Although current safety data are limited, the reported adverse events have generally been mild. Further research is needed to establish its safety, efficacy, and optimal protocols in episodic and chronic migraine populations."

Retrospective data • Review • CNS Disorders • Migraine • Pain

Middle meningeal artery lidocaine infusion for refractory migraine: First case report in Portugal (EHF-EHC 2025) - "Various pharmacologic classes were tried without benefit: antihypertensives and calcium channel blockers (propranolol, candesartan, flunarizine), antiepileptics (valproic acid, topiramate, oxcarbazepine), antidepressants (amitriptyline, nortriptyline, venlafaxine, fluvoxamine, sertraline, clomipramine), other preventives (prednisolone, oxitriptan, melatonin), cycles of botulinum toxin (PREEMPT protocol), monoclonal antibodies (galcanezumab, fremanezumab, erenumab), and atogepant. At the time of the procedure, the patient was on eptinezumab 100 mg and botulinum toxin every three months but continued to have daily headaches, with severe intensity and reliance on eletriptan for acute relief...It constitutes an invasive therapeutic approach that should be considered only as a rescue option for carefully selected patients with severely refractory migraine. Further studies and long-term follow-up are needed to assess efficacy and safety."

Case report • Clinical • Anorexia • CNS Disorders • Migraine • Pain