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

Abstract 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.