Migraine and Headache Studies Peer reviewed

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

Keisuke Suzuki, Shiho Suzuki, Saro Kobayashi, Mukuto Shioda and 4 more

Cephalalgia | Jun 1, 2026

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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.

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ObjectiveTo 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.MethodsWe 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 ( 6 days/month). Patients were further classified by the timing of achieving optimal control.ResultsThe 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.ConclusionsCGRP 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.

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Keisuke Suzuki

first | Dokkyo Medical University | ORCID 0000-0003-0320-8993

Shiho Suzuki

middle | Dokkyo Medical University | ORCID 0009-0007-7430-2078

Saro Kobayashi

middle | Dokkyo Medical University

Mukuto Shioda

middle | Dokkyo Medical University

Hiroaki Fujita

middle | Dokkyo Medical University

Yasuo Haruyama

middle | Dokkyo Medical University | ORCID 0000-0001-6865-5159

Ryotaro Hida

middle | Dokkyo Medical University

Koichi Hirata

last | Dokkyo Medical University | ORCID 0000-0002-6492-4734

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BibTeX

@article{Suzuki2026Real,
  title = {Real-world achievement of higher standards for migraine prevention with CGRP monoclonal antibodies},
  author = {Keisuke Suzuki and Shiho Suzuki and Saro Kobayashi and Mukuto Shioda and Hiroaki Fujita and Yasuo Haruyama and Ryotaro Hida and Koichi Hirata},
  journal = {Cephalalgia},
  year = {2026},
  doi = {10.1177/03331024261453284},
  url = {https://doi.org/10.1177/03331024261453284}
}

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