P022 | REAL-WORLD CGRP-TARGETED THERAPY OUTCOMES IN HIGH-FREQUENCY MIGRAINE: IMPLICATIONS FOR THE 2025 POSITION STATEMENT OF HIS
A. D'Amico1|2, B. Pitzalis3, C. Zilli3, G. Giuliani4, M. Di Giulio3, F. Traccitto3, M. Altieri3 | 1Istituto Neurotraumatologico Italiano - Roma, Italy; 2Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Università degli Studi di Salerno - Baronissi, Italy; 3Dipartimento di Neuroscienze Umane, Università degli Studi di Roma "La Sapienza", Italy; 4Centro Cefalee, Ospedale "San Giovanni Addolorata", Roma, Italy
Abstract
Background. An International Headache Society position statement was proposed in 2025 to state migraine prevention targets: 1. Migraine Freedom (elimination of migraine days) 2. Optimal Control (<4 days/month) 3. Modest Control (4–6 days/month) 4. Insufficient Control (>6 days/month). We evaluated the real-world effectiveness and tolerability of CGRP-targeted therapies in patients with high-frequency episodic migraine (HFEM) and chronic migraine (HFCM) and assessed treatment outcomes according to the IHS higher standards’ framework.
Methods. A single-center, real-world, observational study was conducted at a third-level Headache Center (Policlinico Umberto I, Rome). 330 patients diagnosed with HFEM (n=224) or HFCM (n=106) according to ICHD-3 criteria received CGRP monoclonal antibodies or gepants. Treatment effectiveness was assessed using monthly migraine days recorded in headache diaries and the Patient Global Impression of Change (PGIC). 325 were eligible (268 female, 57 male; mean age 48.3 years). Mean follow-up was 27.8 (SD ±19).
Results. 26 patients (8%) achieved “Migraine Freedom”, 177 (54.5%) “Optimal Control”, 69 (21.2%) “Modest Control”, and 53 (16.3%) “Insufficient Control”. Notably, approximately 10% of patients who improved from near-daily headache to 4–6 monthly migraine days experienced marked gains in daily functioning, work productivity, and quality of life despite not meeting the highest therapeutic target. Many patients also reported reduced attack severity and duration, improved response to acute medication and greater functional recovery.
Conclusions. CGRP-targeted therapies provide sustained long-term benefits in high-frequency migraine. While the IHS framework promotes ambitious treatment goals, rigid frequency-based thresholds may underestimate clinically meaningful improvement in partial responders. Integrating patient-reported outcomes with objective measures may provide a more comprehensive assessment of treatment success and better reflect the multidimensional impact of migraine.
Methods. A single-center, real-world, observational study was conducted at a third-level Headache Center (Policlinico Umberto I, Rome). 330 patients diagnosed with HFEM (n=224) or HFCM (n=106) according to ICHD-3 criteria received CGRP monoclonal antibodies or gepants. Treatment effectiveness was assessed using monthly migraine days recorded in headache diaries and the Patient Global Impression of Change (PGIC). 325 were eligible (268 female, 57 male; mean age 48.3 years). Mean follow-up was 27.8 (SD ±19).
Results. 26 patients (8%) achieved “Migraine Freedom”, 177 (54.5%) “Optimal Control”, 69 (21.2%) “Modest Control”, and 53 (16.3%) “Insufficient Control”. Notably, approximately 10% of patients who improved from near-daily headache to 4–6 monthly migraine days experienced marked gains in daily functioning, work productivity, and quality of life despite not meeting the highest therapeutic target. Many patients also reported reduced attack severity and duration, improved response to acute medication and greater functional recovery.
Conclusions. CGRP-targeted therapies provide sustained long-term benefits in high-frequency migraine. While the IHS framework promotes ambitious treatment goals, rigid frequency-based thresholds may underestimate clinically meaningful improvement in partial responders. Integrating patient-reported outcomes with objective measures may provide a more comprehensive assessment of treatment success and better reflect the multidimensional impact of migraine.
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