Anti-CGRP or anti-CGRP receptor monoclonal antibodies are valuable prophylactic migraine therapy that may be helpful for people with refractory chronic migraine.

To evaluate the efficacy and safety of anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) in patients with refractory chronic migraine, a systematic review was undertaken.

To find out relevant literature, MEDLINE, Scopus, Science Direct, and ClinicalTrials.gov databases were explored. Considering inclusion and exclusion criteria, articles were chosen. Alteration from the baseline in monthly migraine days (MMD); Migraine-specific Quality of Life Questionnaire (MSQ); alteration from the baseline in monthly acute migraine-specific medication days (MAMD);  ≥50% decrease of MMD values from the baseline; and reported side effects were the efficacy and safety outcomes ascertained. In addition, the incorporated studies' risk of bias was assessed utilizing Cochrane risk of bias tool (RoB 2).

A total of four trials were incorporated with 2811 resistant chronic migraine patients. Of them, 667 used Erenumab, 838 used Fremanezumab, and 1306 used Galcanezumab in two separate investigations. All tested anti-CGRP mAbs and their corresponding dosages showed benefit when compared to placebo in lowering MMD, minimizing acute drug use, and raising MSQ scores, occasionally even reverting chronic migraine to episodic migraine (efficacy outcomes).

Concerning the safety results, there was no difference in the quantity or kind of side effects between placebo and anti-CGRP mAb-treated groups.

Hence, anti-CGRP receptor mABs seem to have immense potential for treatment and reversibility of resistant chronic migraine.