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. 2025 Mar;15(3):161-171.
doi: 10.1080/17581869.2025.2470615. Epub 2025 Mar 3.

Effectiveness and safety of anti-CGRP monoclonal antibodies for migraine in patients over 65 years: a systematic review

Albert Muñoz-Vendrell  1 , Alba López-Bravo  2   3   4 , Almudena Layos-Romero  5 , Francisco J Alberola-Amores  6 , María Obdulia Lozano Caballero  7 , Antonio Sánchez-Soblechero  8 , Cristian Morales-Hernández  9 , María Victoria Castro-Sánchez  10 , María Pilar Navarro-López  11 , María Rocío Córdova-Infantes  12 , Edoardo Caronna  13   14 , Pablo Irimia  15 , Alicia Gonzalez-Martinez  16   17 ; junior Headache Group of the Spanish Society of Neurology (jGECSEN)
Affiliations

Effectiveness and safety of anti-CGRP monoclonal antibodies for migraine in patients over 65 years: a systematic review

Albert Muñoz-Vendrell et al. Pain Manag. 2025 Mar.

Abstract

Background: Migraine patients over 65 years have been excluded from pivotal anti-CGRP monoclonal antibody trials leaving limited real-life data on effectiveness and safety in this population. This review aims to summarize available evidence on treatment response and safety for older patients.

Methods: A PubMed and Cochrane Controlled Register of Trials (CENTRAL) search identified studies on anti-CGRP monoclonal antibodies in patients with migraine over 65 up to October 2024. The review focuses on headache outcomes like reduction in monthly migraine days or monthly headache days, response rates (30%, 50%, 75%) and adverse effects of this specific population and/or against placebo, standard care, or younger patients. The quality of evidence was assessed using the GRADE tool.

Results: All eligible studies were included, along with additional articles presented narratively. Data from clinical trials and post-hoc analyses show comparable efficacy and safety between older and younger patients. Similarly, early real-life studies support the use of anti-CGRP monoclonal antibodies in patients over 65 years, showing similar response rates, reductions in monthly migraine days and adverse effects.

Discussion: Anti-CGRP monoclonal antibodies should likely be offered to patients over 65 although available evidence remains limited. Further studies analyzing specific data from this subgroup are necessary.

Keywords: 65 years; Anti-cgrp monoclonal antibodies; elderly; migraine; older.

Plain language summary

Migraine in older adults can be more challenging to diagnose and treat due to changes in symptoms and the presence of other health conditions. These factors may limit treatment options. A new class of migraine treatments, called anti-CGRP monoclonal antibodies, has shown promising results in younger patients, but older adults were not included in key clinical trials. This review looks at the available research on how well these treatments work and how safe they are for people over 65. We analyzed studies that included older adults using these medications. The findings suggest that anti-CGRP monoclonal antibodies can reduce migraine frequency and severity in older patients, with effectiveness and side effects similar to those seen in younger adults, showing that they help patients who have not responded to other preventive treatments. However, the number of studies focusing on this age group is still limited. Overall, anti-CGRP monoclonal antibodies appear to be a good treatment option for older adults with migraine, provided they have no conditions that would make the treatment unsafe. However, more research is needed to better understand their long-term effects, particularly in patients with heart and blood vessel conditions, which are more common in this age group.

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Conflict of interest statement

AMV has received honoraria for advisory board participation, consulting, scientific communications, and research support, as well as funding for travel and congress attendance from Teva, Lilly, Organon, Roche, UCB, Bial, Chiesi, Abbvie, Kern Pharma, Pfizer, Janssen, Biogen Idec, BMS, Novartis, Merck, Sanofi and/or Almirall. ALB has received speaker honoraria from Teva, Lilly, Novartis, Lundbeck, Almirall, Bial, Eisai, and Viatris. ALR has received honoraria for medical education and consulting with Abbvie, Lilly, Lundbeck, Novartis and Teva, she is current coordinator of the young Spanish Headache Group of the Spanish Society of Neurology. ASS has received honoraria for related lectures from TEVA. CMH has received speaker honoraria from Abbvie, Lilly, Lundbeck, Novartis and Teva. MCS has received speaker honoraria from Teva, Lilly, Novartis, Lundbeck, Almirall, Abbvie and Pfizer. MCI has received speaker honoraria from TEVA and UCB. EC has received honoraria from Novartis, Chiesi, Lundbeck, MedScape; his salary has been partially funded by Acción Estratégica en Salud, Instituto de Salud Carlos III, through the Río Hortega grant (CM20/00217) and Juan Rodes grant (JR23/00065). He is a junior editor for Cephalalgia. PI received honoraria from TEVA, Novartis, Lilly, Abbvie, Lundbeck, Pfizer and is a board member of the Spanish Headache Group of the Spanish Society of Neurology. AGM has received speaker honoraria from TEVA, Lilly and Altermedica. FAA, MLC and MNP report no conflicts of interest, her salary has been partially funded by Acción Estratégica en Salud, Instituto de Salud Carlos III, through the Río Hortega grant (CM21/00178) and Juan Rodes grant (JR23/00005), she is the Principle Investigator of the national I+D+I project (PI24/01085) and she is current coordinator of the young Spanish Headache Group of the Spanish Society of Neurology. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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