Effectiveness of anti-CGRP monoclonal antibodies on central symptoms of migraine

Cephalalgia. 2022 Nov;42(13):1323-1330. doi: 10.1177/03331024221111526. Epub 2022 Jul 1.


Background: Clinical trials and observational studies with anti-calcitonin gene-related peptide antibodies poorly investigated their impact on migraine prodromal and accompanying symptoms. This information might help deciphering the biologics' pharmacodynamic and provide hints on migraine pathogenesis. Herein, we report the effects of erenumab, fremanezumab and galcanezumab on attack prodromal and accompanying symptoms and on neurological and psychiatric traits. .

Methods: An explorative, prospective, questionnaire-based study was completed by a cohort (n = 80) of patients with chronic migraine patients presenting a sustained reduction of ≥50% of Migraine Disability Assessment Score and ≥30% of monthly migraine days three months after anti-calcitonin gene-related peptide antibodies treatment.

Results: The majority of patients experienced a complete prevention of migraine symptoms without evidence of initial onset followed by attack abortion. Few patients reported the recurrence of prodromal (from 10% to 12.5%) or accompanying (from 1.3% to 8.8%) symptoms without headache. All patients with migraine with aura reported a decrease of aura incidence. Sleep changes (51.2%), increase in appetite (20.0%) and weight (18.8%) as well as a reduction in stress (45.0%), anxiety (26.3%), and panic attacks (15%) were also reported.

Conclusion: Anti-calcitonin gene-related peptide antibodies seems to significantly impact brain functions of migraineurs, preventing not only migraine headache but also its anticipatory and accompanying symptoms.

Keywords: CGRP; Erenumab; chronic migraine; fremanezumab; galcanezumab; migraine symptoms.

MeSH terms

  • Antibodies, Monoclonal / therapeutic use
  • Calcitonin Gene-Related Peptide / therapeutic use
  • Calcitonin Gene-Related Peptide Receptor Antagonists* / therapeutic use
  • Humans
  • Migraine Disorders* / drug therapy
  • Migraine Disorders* / prevention & control
  • Prospective Studies


  • Calcitonin Gene-Related Peptide Receptor Antagonists
  • Calcitonin Gene-Related Peptide
  • Antibodies, Monoclonal