Calcitonin Gene-Related Peptide-Targeted Migraine Prevention in the Gulf Cooperation Council: A Structured Evidence Review of Guidelines, Access, and Patient-Stratified Care
Abstract
International guidance increasingly permits calcitonin gene-related peptide (CGRP)-targeted therapies to be considered at the initial preventive-treatment decision, but clinical eligibility does not ensure registration, reimbursement, practical access, or first prescribing. We reviewed contemporary preventive evidence and used the six Gulf Cooperation Council (GCC) health systems as a regional test case for this evidence-to-access gap. This structured evidence review used a focused PubMed/MEDLINE working set of 2,443 records through September 1, 2026, complementary bibliographic and trial-registry searches, professional guidance, and targeted GCC regulatory, procurement, and real-world sources. Prioritized assessment included 248 full texts and a 135-document working evidence corpus. A targeted update on September 29, 2026 checked for additional major guidance and head-to-head evidence without altering the original numerical workflow. Network meta-analyses support efficacy across several established and CGRP-targeted preventives but do not establish a simple class hierarchy. In their respective trials, HER-MES and TEMPLE reported lower adverse-event discontinuation and higher at least 50% responder rates with erenumab and atogepant than with topiramate; their populations and single-comparator designs limit generalization to universal first-treatment superiority. AAN/AHS 2026 emphasizes individualized choice; NICE and 2026 BASH guidance illustrate how national access pathways…
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