Novel Pharmacotherapies for Migraine Prevention: A Systematic Review
Abstract
Background: Migraine is a prevalent neurological disorder associated with substantial disability and reduced quality of life. Recent advances in migraine pathophysiology have led to the development of novel preventive pharmacotherapies, including calcitonin gene-related peptide (CGRP)-targeted monoclonal antibodies, gepants, and other emerging mechanism-based therapies. This systematic review aimed to evaluate the efficacy, safety, and clinical utility of these novel agents in migraine prevention. Material and Methods: A systematic search of PubMed/MEDLINE, Scopus, Web of Science, Embase, and Google Scholar was conducted for studies published between January 2020 and December 2025. Eligible studies included randomized controlled trials, systematic reviews, meta-analyses, narrative reviews, and real-world observational studies evaluating novel pharmacotherapies for episodic or chronic migraine prevention. Nineteen studies meeting predefined eligibility criteria were included in the qualitative synthesis. Results: The included studies consistently demonstrated that novel preventive therapies significantly reduced monthly migraine days, headache frequency, and migraine-related disability. CGRP-targeted monoclonal antibodies and gepants showed favorable efficacy across episodic and chronic migraine populations, including patients with prior preventive treatment failures. Long-term extension studies and real-world investigations reported sustained effectiveness, high treatment…
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