A major new review of migraine treatments suggests that a newer group of medications may offer better relief for people living with chronic migraine.
Researchers found that drugs known as CGRP-targeted therapies appear to reduce migraine attacks more effectively and may cause fewer side effects than many older medications.
The findings were published in the journal Annals of Internal Medicine and are based on an analysis of 43 clinical trials involving adults with chronic migraine.
Migraine is more than just a bad headache. It is a neurological condition that can cause intense head pain, nausea, vomiting, dizziness, and sensitivity to light and sound. Some people also experience vision changes or warning symptoms called aura before a migraine attack begins.
For people with chronic migraine, the condition can become especially disabling. Doctors define chronic migraine as headaches occurring on 15 or more days each month, with at least some of those headaches having migraine features.
Living with chronic migraine can affect nearly every part of daily life. Many patients struggle to work, sleep, socialize, or care for family responsibilities because of the constant pain and unpredictability of attacks.
Although several medications are available, finding the right treatment has often been difficult. Some older migraine drugs may help certain patients, but they can also cause side effects that make long-term treatment challenging.
The new review was led by Malahat Khalili from the Michael G. DeGroote Institute for Pain Research and Care at McMaster University in Hamilton, Ontario, Canada.
Researchers carefully analyzed 43 clinical studies that tested different migraine treatments in adults with chronic migraine.
The strongest evidence supported a newer category of drugs called CGRP-targeted therapies.
CGRP stands for calcitonin gene-related peptide. This is a protein found in the brain and nervous system that plays an important role in migraine attacks.
During migraines, CGRP levels rise sharply. This increase contributes to inflammation, pain signaling, and blood vessel changes linked to migraine symptoms.
CGRP-targeted therapies are designed to block the effects of this protein and interrupt the migraine process before severe symptoms develop.
The review found that these medications reduced the number of monthly migraine days by about two days on average compared with placebo treatment.
While two fewer migraine days may sound modest, researchers say the improvement can make a meaningful difference for people experiencing headaches most days of the month.
The study also found that CGRP therapies were generally well tolerated. Patients taking these drugs tended to report fewer side effects than patients using many older migraine medications.
Examples of CGRP-targeted therapies include eptinezumab, sold under the brand name Vyepti, and atogepant, sold as Qulipta.
These medications are available in several forms, including injections, intravenous infusions, pills, and nasal sprays. This variety may allow doctors to better match treatment methods to patient preferences and medical needs.
The researchers also reviewed evidence for botulinum toxin treatment, commonly known as Botox.
Botox is sometimes used to prevent chronic migraine by relaxing muscles and affecting pain signaling pathways.
The review suggested that Botox may help some patients, but the evidence supporting its effectiveness was less certain than the evidence for CGRP-targeted therapies.
Researchers also found that Botox treatment was associated with more side effects and higher rates of treatment discontinuation.
The review examined older migraine medications as well, including topiramate, valproate, and propranolol.
These drugs have been used for many years to help prevent migraines, but the researchers found that evidence supporting them was weaker and less reliable compared with newer therapies.
Some older medications may still help certain patients, especially when newer treatments are unavailable or too expensive. However, side effects can sometimes limit their usefulness.
For example, some migraine prevention drugs may cause fatigue, dizziness, weight changes, mood effects, or difficulty concentrating.
The researchers stressed that more studies are still needed, especially independent research examining the long-term safety and effectiveness of CGRP-targeted therapies.
Because many of the newer medications are relatively recent, scientists are still learning how patients respond over many years of treatment.
Researchers also say cost remains an important issue. Some of the newer migraine drugs can be expensive, and insurance coverage may vary depending on the country or health system.
As a result, doctors often need to consider several factors when helping patients choose treatment, including symptom severity, medical history, side effects, lifestyle, convenience, and financial concerns.
The researchers emphasized that there is no single treatment that works perfectly for everyone with chronic migraine.
Instead, migraine care often requires an individualized approach tailored to each patient’s needs and preferences.
Experts encourage patients living with chronic migraine to speak openly with their healthcare providers about available treatment options and possible side effects.
Researchers hope the findings will help improve migraine care and guide future studies into safer and more effective therapies.
Overall, the review suggests that CGRP-targeted therapies represent one of the most promising advances in migraine treatment in recent years and may provide better relief for many people struggling with chronic migraine.
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The findings were published in Annals of Internal Medicine.
