CGRP monoclonal antibodies deliver early, sustained functional improvement in adolescent migraine
Background
Adolescent migraine is a highly disabling neurological disorder that significantly impacts daily life, particularly school attendance and concentration. While calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) have emerged as effective preventive therapies for adults, evidence supporting their use and early functional outcomes in adolescents remains limited. This gap highlights the need for real-world data to understand the rapid recovery potential of CGRP mAbs, which is crucial for maintaining normal functioning during this critical developmental stage.
Study Design
This single-center retrospective cohort study investigated 34 Japanese adolescents aged 15-17 years receiving CGRP mAb therapy for migraine between May 2021 and July 2025. Patients were treated with either galcanezumab, fremanezumab, or erenumab. The primary outcome was time to clinically meaningful improvement, defined as a reduction of ≥ 6 points from baseline on the Headache Impact Test-6 (HIT-6) scores, analyzed using the Kaplan-Meier method. Secondary outcomes included longitudinal HIT-6 trajectories via mixed-effects models and questionnaire-based daily functioning assessments.
Results
Of 34 adolescents initiating CGRP mAb therapy, 33 were included in HIT-6 analyses. The cumulative response rate, indicating a clinically meaningful improvement, began increasing immediately after treatment initiation. It reached 68.3% (95% confidence interval = 44.6-81.8%) within the 10-14-week period, with approximately half of these responders achieving meaningful improvement by weeks 4-6. Mixed-effects models, adjusted for baseline HIT-6 scores, demonstrated a least-squares mean change of -9.4 points at 12 weeks (95% confidence interval = -14.2 to -4.6; p < 0.001), with these benefits sustained throughout the follow-up period. Among 27 questionnaire respondents, school attendance or classroom concentration was the most affected activity before treatment (70.4%). Post-treatment, 88.9% indicated their primary treatment goals were mostly or partially achieved. Adverse events were reported by 40.7% of participants.
Key Findings
- CGRP mAb therapy led to clinically meaningful
HIT-6improvement (≥6-point reduction) in 68.3% of adolescents within 10-14 weeks. - Approximately half of the responders achieved meaningful
HIT-6improvement by weeks 4-6. - Mean
HIT-6scores improved by -9.4 points at 12 weeks (p < 0.001), with sustained benefits. - Before treatment, 70.4% of adolescents reported impaired school attendance or concentration.
- Post-treatment, 88.9% of respondents reported achieving their primary treatment goals.
Why It Matters
This study provides compelling real-world evidence that CGRP mAbs offer rapid and sustained functional improvement for adolescents with migraine, a population where data has been scarce. Clinicians can now consider CGRP mAbs as a viable option for adolescents, particularly those struggling with school attendance and concentration due to migraine. The early onset of benefit, with half of responders improving within 4-6 weeks, is a critical factor for this age group, enabling a quicker return to normal daily and academic activities. While specific dosing protocols were not detailed, the observed efficacy across multiple CGRP mAbs suggests a class effect, reinforcing their potential role in adolescent migraine management.
migraine
adolescent
cgrp-mab
galcanezumab
fremanezumab
erenumab