A review in Annals of Internal Medicine finds most CGRP-targeted therapies cut migraine days by about two per month. Evidence for older medications was weaker, according to researchers.
Chronic migraine can be difficult to treat—but new research is helping identify the most effective options.
In a large new review, researchers analyzed 43 clinical trials involving adults with chronic migraine, defined as headaches on 15 or more days a month.
The strongest evidence pointed to a newer class of medications called CGRP-targeted therapies, according to the results.
These drugs were shown to reduce monthly migraine days by about two and were generally well tolerated.
CGRP is a protein found in the brain and nervous system that spikes during migraines, triggering pain and inflammation. These drugs are designed to block that process.
Available as shots, infusions, pills, and a nasal spray, they were also found to have fewer side effects than older treatments.
By comparison, the evidence showed botulinum toxin, or Botox, may offer some benefit, but with less certainty and more side effects leading to treatment drop-off.
For older medications like topiramate, valproate, and propranolol, the evidence was also limited and even less reliable.
The researchers say more independent studies on CGRP therapies are needed, especially on long-term safety and adherence.
The authors add while newer therapies appear to show the most promise— the right treatment depends on a patient’s individual needs, preferences, and cost.
They recommend talking with your health care provider to find the best option for you.
Source: Annals of Internal Medicine
Author Affiliations: McMaster University, University of New South Wales, Isfahan University of Medical Sciences, Mazandaran University of Medical Sciences, Universite de Montreal, Shiraz Islamic Azad University, Kerman University of Medical Sciences, University of Toronto, Fortis Healthcare Research Foundation, Karolinska Institutet
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