Tracking migraine outcomes over time by age and monoclonal antibody type: a retrospective, single-center, real-world study
Abstract
Background: Calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) are established preventive treatments for episodic and chronic migraine, but comparative longitudinal data across agents and age groups remain limited. This study aimed to evaluate long-term responses to different CGRP mAbs, assess whether age or treatment type influences response trajectories, and characterize multidimensional patterns of clinical response.
Methods: We conducted a retrospective, single-center observational study including 453 adults with episodic or chronic migraine treated with erenumab, galcanezumab, fremanezumab, or eptinezumab between November 2018 and April 2026. Patients were stratified by age (<50 vs. ≥ 50 years) and different CGRP mAbs treatment. Longitudinal mixed-effects models assessed changes in monthly migraine days, acute medication use, pain intensity, disability, quality of life, and mood over 12 months. Generalized linear mixed models evaluated predictors of ≥50% response. Principal component analysis (PCA) was used to identify multidomain response patterns.
Results: All CGRP mAbs produced rapid and sustained improvements across migraine frequency, disability, and patient-reported outcomes over 12 months. Age did not significantly influence baseline severity, longitudinal trajectories, or responder status. Treatment differences were modest overall; however, at 12 months, fremanezumab and eptinezumab were associated with higher odds of response compared with…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 453 participants or records.
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