Anti-CGRP Therapy Improves Sleep Quality and Reduces Daytime Sleepiness in Patients With Migraine

A new observational study published in Headache and Pain Research, researchers reported that patients with episodic or chronic migraine experienced significant improvements in sleep quality and daytime sleepiness after starting monoclonal antibody (mAb) therapy targeting the calcitonin gene-related peptide (CGRP) pathway. These findings highlight the relationship between migraine and sleep disturbances, suggesting that effective migraine management may improve sleep health across different migraine types.¹

Among 109 patients who completed the study (women, 86.4%; mean age, 43.6 years), a significant improvement on the Portuguese version of the Pittsburgh Sleep Quality Index (PSQI-PT)² was observed in patients initiating CGRP mAb therapy, with median PSQI-PT scores decreasing from 9 at baseline to 6 at 6 months (P <.001). Notably, researchers observed a reduction on the Portuguese version of the Epworth Sleepines Scale (ESS-PT), with the median ESS score decreasing from 7 to 6 (P =.04).

““The findings of this study have important clinical implications emphasizing the association between reduced migraine burden and better subjective sleep quality in patients treated with anti-CGRP mAbs, rather than implying a direct therapeutic sleep effect. Given the high prevalence of sleep disturbances in migraine patients, routine assessment of sleep parameters in clinical practice may enhance patient management and optimize treatment outcomes,” lead author Rita Cagigal, MD, neurologist at Private Hospital of Beiras in Portugal, and colleagues wrote.¹

This prospective, multicenter, longitudinal study was conducted across 12 headache centers between March 1 and December 31, 2023. The study cohort included 118 patients with migraine who began anti-CGRP mAb therapy, specifically fremanezumab (Ajovy; Teva Pharmaceuticals), galcanezumab (Emgality; Eli Lilly), or erenumab (Aimovig; Amgen) The primary end point was the change in sleep quality, measured by the PSQI-PT score, from baseline to 6 months. Secondary end points included changes in PSQI-PT and ESS-PT scores at 3 months and 6 months. Participants used headache diaries to track migraine days, pain intensity, and medication use.

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Nine participants (7.6%) discontinued the study, including 3 because of treatment inefficacy at the 3-month evaluation and 6 who were lost to follow-up. At baseline, 40.7% of patients had a diagnosed sleep disorder, 91% of which were insomnia. Other reported conditions included sleep-related breathing disorders, sleep-related movement disorders, and circadian rhythm sleep-wake disorders. Regarding migraine classification, 52% of patients had episodic migraine and 48% had chronic migraine. In addition, researchers reported that fremanezumab was the most frequently used mAb therapy (66%).

Following 6 months of CGRP monoclonal antibody treatment, investigators observed a significant reduction in migraine burden. The median number of monthly headache days decreased from 13 at baseline to 4 at 6 months (P <.001), and the number of days with severe headache decreased from 10 to 2 (P <.001).

All told, treatment efficacy was significantly associated with improved sleep quality (P <.05). Patients with greater reductions in migraine frequency and severity also experienced greater improvements in PSQI-PT scores. However, authors noted that there was no significant correlation was observed between Portuguese version of the ESS-PT scores and treatment efficacy.

“Future research should focus on elucidating the precise mechanisms underlying these associations. Objective sleep measures such as polysomnography and actigraphy could provide deeper insights into how migraine improvement correlates with changes in sleep quality,” Cagigal et al noted.¹ “A deeper understanding of CGRP’s role in sleep-wake regulation could not only refine migraine treatment but also unlock new therapeutic strategies for sleep disorders. As CGRP-targeted therapies continue to evolve, their potential impact on both migraine burden and sleep health warrants further exploration.”

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REFERENCES
1. Cagigal R, Fonseca A, Martins B, et al. The Impact of Anti-Calcitonin Gene-Related Peptide Monoclonal Antibodies on Sleep Quality and Daytime Sleepiness in Migraine Patients: A Multicenter Study. Headache Pain Res. Published online January 28, 2026. doi:10.62087/hpr.2025.0022
2. Del Rio João KA, Becker NB, de Neves Jesus S, Isabel Santos Martins R. Validation of the Portuguese version of the Pittsburgh Sleep Quality Index (PSQI-PT). Psychiatry Res. 2017;247:225-229. doi:10.1016/j.psychres.2016.11.042