Preliminary evidence of long-term safety and effectiveness of anti-CGRP drugs for migraine prevention in people with comorbid epilepsy: A 52-week follow-up retrospective study.

Migraine and epilepsy frequently coexist, but evidence on the safety of calcitonin gene-related peptide (CGRP)-targeting therapies in people with epilepsy is lacking. We evaluated long-term migraine and epilepsy outcomes in a real-world multicenter retrospective cohort of adults with comorbid migraine and epilepsy treated with anti-CGRP monoclonal antibodies or gepants while on stable antiseizure medications. Eleven patients were included in the final analysis, all female, with a mean age of 34.7 ± 12.2 years. At baseline, mean monthly headache days (MHDs) were 18.5 ± 7.8, with 54.5% episodic migraine and 45.5% chronic migraine; 72.7% of patients had drug-resistant epilepsy, and baseline mean monthly seizure frequency was 0.75. Mean MHDs decreased to 7.6 ± 5.5 at 24 weeks and to 5.4 ± 3.2 at 52 weeks (p < 0.001). At week 24, 90% of patients achieved a ≥50% reduction in MHDs, which was maintained at week 52; ≥75% response increased from 10% at week 24 to 20% at week 52, and 10% achieved migraine freedom at 1 year; MIDAS and HIT6 scores decreased significantly from baseline to both 24 and 52 weeks (all p < 0.001). Acute medication days and intake were reduced by over 85% at the end of the study. Seizure frequency did not increase during follow-up and showed a non-significant numerical reduction to 0.40 monthly seizures at 52 weeks (p = 0.423). No seizure exacerbations or treatment-related adverse events were observed. This study provides preliminary, long-term observations suggesting that anti-CGRP therapies may be effective for migraine prevention in patients with comorbid epilepsy. No adverse events or apparent worsening of seizure frequency were observed during the 52-week follow-up. These findings require confirmation in larger, prospective controlled studies. PLAIN LANGUAGE SUMMARY: Migraine and epilepsy often occur together, but information on CGRP-targeting migraine medicines in people with epilepsy is limited. We reviewed records from 11 women with both conditions over 1 year. Headache, migraine-related disability, and use of medicines for attacks decreased. Among 10 women with complete migraine follow-up, nine had at least half as many headache days at both 6 months and 1 year. No worsening of seizures or treatment-related side effects was reported. These findings are encouraging, but this small study without a comparison group cannot establish safety or prove treatment benefit.