Hair loss in the era of CGRP inhibition: emerging evidence, mechanisms, and clinical implications
Abstract
Introduction: Calcitonin gene-related peptide (CGRP)-targeting therapies have transformed migraine management and are generally associated with a favorable safety profile. However, accumulating real-world evidence suggests a potential association with alopecia that was not systematically captured in pre-approval clinical trials. This review aimed to synthesize current evidence on alopecia associated with CGRP-targeting therapies, with a focus on clinical patterns, pharmacovigilance signals and underlying pathophysiological mechanisms.
Methods: A structured literature search of PubMed was conducted to identify relevant evidence on CGRP-targeting therapies and hair loss through August, 2026. Eligible studies included clinical trials, observational studies, pharmacovigilance analyses and case reports reporting alopecia outcomes. Reference lists were screened for additional relevant studies. Due to heterogeneity of study designs and predominance of low-level evidence, findings were synthesized narratively without formal quality assessment.
Results: Evidence from pharmacovigilance data and case-based observations suggests a reproducible signal of predominantly reversible, non-scarring alopecia occurring within weeks to months after initiation of CGRP-targeting therapies. Reports span multiple monoclonal antibodies and gepants, supporting a potential class effect. However, the available evidence is largely derived from spontaneous reporting systems and case series, limiting causal…
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