Anxiety and Depression Symptoms During CGRP-Targeted Therapy in Patients with Migraine: A Retrospective Cohort Study from the United Arab Emirates

Anxiety and depressive symptoms are common in migraine. Whether calcitonin gene-related peptide (CGRP)-targeted therapies improve these symptoms, and whether improvement is coupled to headache reduction, remains unclear. This was a single-center, retrospective, descriptive pre-post cohort study of adults with migraine and documented anxiety and/or depression initiating a CGRP monoclonal antibody or gepant in the United Arab Emirates (UAE). Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scores at baseline and 6 months post treatment initiation were compared using the Wilcoxon signed-rank test. Responder rates (≥ 4-point drop in GAD-7 score, ≥ 5-point drop in PHQ-9 score) were computed among patients able to reach each threshold. Between-molecule differences were tested using the Kruskal–Wallis test. Spearman correlation was used to explore the association between change in monthly migraine days (ΔMMD) and mood change. Of the 121 adults who initiated treatment, 113 had paired baseline and 6-month score data (mean [± standard deviation] age 38.9 ± 9.5 years; 83.2% female; 55.8% chronic migraine). At 6 months, the GAD-7 score had fallen from 6.0 ± 4.0 to 2.7 ± 2.9 and the PHQ-9 score had dropped from 9.3 ± 4.9 to 4.3 ± 3.7 (both p < 0.001). MMD fell from 9.1 ± 5.1 to 3.0 ± 2.6 ( p < 0.001). Responder rates were 59.8% (49/82) for adults according to GAD-7 scores and 54.8% (51/93) according to PHQ-9 scores. Scores decreased within every CGRP-targeted molecule subgroup, with no detectable between-molecule differences (Kruskal–Wallis p = 0.34 for ΔGAD-7; p = 0.68 for ΔPHQ-9). ΔMMD correlated only weakly with mood change ( ρ = 0.04 for ΔGAD-7; ρ = 0.15 for ΔPHQ-9; both non-significant). A worsening PHQ-9 item 9 response (thoughts of death or self-harm) was recorded in one of 113 patients. CGRP-targeted therapies were associated with significant reductions in anxiety and depressive symptoms in this UAE cohort, although the eptinezumab and atogepant subgroups were small. No detectable association was found between changes in migraine days and mood scores. These hypothesis-generating findings warrant confirmation in controlled, prospective studies.