Efficacy, tolerability and barriers to the use of anti-CGRP medications among migraine patients in Egypt: real world experience

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Background With the introduction of anti-CGRP therapies in Egypt in 2019, there is a growing need to evaluate their real-world use, including effectiveness, tolerability, barriers to access, and treatment adherence among migraine patients. This study aimed to describe the clinical outcomes, tolerability, and barriers to the use of anti-CGRP therapies in an Egyptian cohort. Methods In this descriptive observational study, migraine patients who were prescribed anti-CGRP therapy were assessed using headache diaries, MIDAS, and HIT-6 at baseline, with follow-up at one and three months after treatment initiation. Patients were also evaluated for background headache and medication overuse headache pre- and post-treatment, the reasons for treatment discontinuation, and relapse rate after drug discontinuation (defined as loss of ≥50% of initial improvement). Results A total of 80 patients (62 chronic and 18 episodic migraine) received Erenumab, Galcanezumab, or Rimegepant. Overall, 54 patients (68%) showed a favorable ≥50% response, with clinically significant reduction in monthly migraine days, headache severity, duration, HIT-6 and MIDAS scores ( p < 0.001), as well as prevalence of background headache and medication overuse. Tolerability was generally favorable and treatment discontinuation occurred in 35 patients, primarily due to either satisfactory improvement, lack of improvement or cost, and was associated with relapse in 42.1% of cases. Conclusion This study provides real-world insights into the use of anti-CGRP therapies among migraine patients in Egypt, demonstrating consistent clinical improvement and good tolerability. It also highlights important challenges related to treatment access and adherence. Findings should be interpreted in the context of observational design of the study, and further controlled studies are warranted.