Why a good result of migraine treatment may not be good enough

High standards of migraine care, defined as optimal disease control or even migraine freedom, were achieved in a real-world setting with anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies in approximately 40% of individuals with a high migraine burden. Over a quarter of patients who were considered ‘insufficiently controlled’ achieved a ≥50% response.

In a position statement, the International Headache Society (IHS) recently advocated for raising the standards of migraine prevention by proposing new treatment goals for migraine prevention in the real-world setting [1]. The IHS emphasised that achieving a ≥50% reduction in monthly migraine days is considered a successful response, but may not fully restore quality-of-life. In the newly defined IHS treatment goals, a ≥50% reduction in monthly migraine days can still be rated as ‘insufficient control’. Dr Edoardo Caronna (Vall d’Hebron University Hospital, Spain) presented results of the first study assessing the proportion of individuals achieving the new IHS treatment goals after 6 months of treatment with anti-CGRP monoclonal antibodies [2]. These treatment goals were categorised as follows:

• migraine freedom (0 days with migraine or moderate-to-severe headache per month);
• optimal control (≤4 days with migraine or moderate-to-severe headache per month);
• modest control (5-6 days with migraine or moderate-to-severe headache per month);
• insufficient control (>6 days with migraine or moderate-to-severe headache per month).

Dr Caronna and colleagues assessed the proportion of participants in the EUREkA-cohort in each treatment goal category after 6 months. EUREkA is a European multicentre, prospective, real-world study of adult patients with migraine who are treated with anti-CGRP monoclonal antibodies. There were 4,963 participants with 6 months of data available. Median age was 48.0 years; 82.3% were female. At baseline, the median number of monthly migraine days was 15.0; the median number of monthly headache days was 20.0.

At baseline, all patients had insufficient control. After 6 months of treatment, 342 (6.9%) had migraine freedom, 1,589 (32.0%) had optimal control, 771 (15.5%) had modest control, and 2,261 (45.6%) had insufficient control. All in all, 1,931 (38.9%) had ≤4 days with migraine or moderate-to-severe headache after 6 months of treatment (see Figure).

Figure: ≥50% responders (cross-hatched) across new treatment goal groups [2]



As the figure illustrates, 613 (27.1%) in the insufficient control group had a ≥50% reduction in monthly headache days. “These patients have such a high baseline number of monthly migraine days that their migraine frequency remains above the threshold for optimal control,” commented Dr Caronna. He added that future studies should explore whether initiating migraine-specific preventive treatments earlier may further reduce residual migraine days in responders.

1. Sacco S, et al. Cephalalgia. 2025;45(2):3331024251320608.
2. Caronna E, et al. Achieving higher standards in real-world migraine care with anti-CGRP monoclonal antibodies. LBN_01, EAN Congress 2025, 21-24 June, Helsinki, Finland.

Copyright ©2025 Medicom Medical Publishers



Posted on 3 September 2025