For or against? Anti-CGRP monoclonal antibodies as a first-line therapy for migraines

Simona Sacco, MD, University of L’Aquila, L’Aquila, Italy, comments on whether the newly introduced calcitonin gene-related peptide (CGRP)-targeted monoclonal antibodies should be used as first-line prevention for migraines. Although these monoclonal antibodies give substantial benefits to many patients, Prof. Sacco recognizes that there are some shortcomings, including higher direct costs, lack of head-to-head evidence showing them to be more effective than conventional options, and the fact that the optimal first-line therapy depends on the patient in question. Regarding direct costs, more expensive therapies are usually allocated to the patients most in need of them, including those suffering from a higher burden of headache, medication overuse headache, or comorbidities that hinder the use of conventional drugs. This interview took place at the European Academy of Neurology (EAN) 2022 Congress in Vienna, Austria.