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CC BY 4.0 · Arq Neuropsiquiatr 2025; 83(09): s00451809658
DOI: 10.1055/s-0045-1809658
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Calcitonin gene-related peptide monoclonal antibodies and medication overuse headache: is stopping excessive pain medication still necessary?

João José Freitas de Carvalho 
1   Faculdade de Medicina Unichristus, Fortaleza CE, Brazil.
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Abstract

Recent studies demonstrate a significant paradigm shift concerning migraine patients suffering from medication overuse (MO). Traditionally, doctors used to demand that patients who overused medications be withdrawn before beginning any preventive therapy; however, such a belief has recently been challenged by emerging evidence about the benefit of calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs), which have shown similar effectiveness in several clinical trials and real-world studies, regardless of whether a patient has previously stopped taking excessive medications. The data indicates that patients undergoing CGRP mAb therapy naturally decreased their acute medication consumption as migraine frequency diminished without requiring forced discontinuation. Furthermore, safety analyses have confirmed favorable tolerability profiles when CGRP mAbs are administered concurrently with various acute medications. This new evidence-based approach offers several clinical advantages, including enhanced treatment adherence and reduced risk of withdrawal complications. These findings support transitioning from mandatory detoxification protocols toward more individualized treatment strategies, representing a significant advancement in clinical migraine management.

Keywords

Headache - Headache Disorders, Secondary - Migraine Disorders - Tension-Type Headache - Therapeutics - Analgesics

This article is part of a debate series on Headache and Pain (CGRP Monoclonal Antibodies for Migraine), featuring different perspectives. Check out the other points of view: https://doi.org/10.1055/s-0045-1809333 and https://doi.org/10.1055/s-0045-1809332.


Data Availability Statement

All data analyzed in the present review were obtained from previously published studies as cited in the references.


Editor-in-Chief: Hélio A. G. Teive 0000-0003-2305-1073.


Associate Editor: Carlos Henrique Ferreira Camargo 0000-0002-3533-0347.


Guest Editor: Pedro Augusto Sampaio Rocha Filho 0000-0001-5725-2637.




Publication History

Received: 11 February 2025

Accepted: 09 March 2025

Article published online:
28 July 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
João José Freitas de Carvalho. Calcitonin gene-related peptide monoclonal antibodies and medication overuse headache: is stopping excessive pain medication still necessary?. Arq Neuropsiquiatr 2025; 83: s00451809658.
DOI: 10.1055/s-0045-1809658
 

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