This study aimed to assess how multiple (n=3) 12-month treatment cycles (TC) with anti-CGRP monoclonal antibodies (mAbs) impacts on migraine course by comparing migraine frequency after the discontinuation of the first, second and third TC (D1, D2 and D3, respectively).

This real-life, multicenter, prospective study involved consecutive patients with high-frequency episodic migraine (HFEM) or chronic migraine (CM) who had experienced multiple (>3) treatment failures and were treated with ≥3 consecutive treatment cycles (TC) of anti-CGRP mAbs. Primary endpoint was the variation in ≥ 50% response rate (RR) at D3 vs D1 and D2. Secondary endpoints included variations in monthly migraine days (MMD) for HFEM or monthly headache days (MHD) for CM, monthly analgesic medications (MAM), Numeric Rating Scale (NRS), and Headache Impact Test (HIT-6) scores, ≥75% RR and relapse from episodic migraine to CM and from no-medication overuse (MO) to MO at D3 vs D1 and D2.

Two-hundred-twelve patients completed 3 TC. The ≥ 50% RR at weeks 45–48 during the first, second and third TC were 92.9%, 94.8% and 96.2%, respectively. Corresponding rates at D1, D2 and D3 were 25%, 53.8% (p <0.001 vs D1) and 77.8% (p <0.001 vs D1 and D2). Significant reductions (p < 0.001) in MMD, MHD, MAM, NRS, and HIT-6 scores and ≥75% RR were observed at D3 compared to D1 and D2. At D3, the relapse rate from episodic to chronic migraine was 0.9% (p = 0.06, vs D2), 7.1%, at D2 (p < 0.001, vs D1) and 24.1% at D1. Similarly, only 1.4% of patients relapsed from no-MO to MO at D3, compared to 48.3% at D1 (p < 0.001) and 12.3% at D2 (p < 0.001).