Anti-CGRP monoclonal antibodies and migraine with aura: a narrative review

Background: Monoclonal antibodies against the calcitonin gene-related peptide (anti-CGRP mAbs) have been a game-changer in migraine treatment over the last decade. However, data regarding the reduction in the frequency of episodes of migraine with aura are limited, as no trials have been specifically designed to evaluate this outcome. Methods: In this narrative review, we summarized clinical data from both randomized controlled trials (RCTs) and real-world studies (RWSs) on the efficacy and effectiveness of anti-CGRP mAbs in patients with migraine with aura and aura symptoms. Results: Overall, anti-CGRP mAbs can reduce migraine frequency and burden regardless of the presence of aura, with efficacy and effectiveness in both patients with and without aura. A few studies suggested a potential influence on reducing aura occurrence. However, several limitations affect the available studies and prevent definitive conclusions regarding the effects of anti-CGRP mAbs on aura. Conclusions: Further studies specifically aimed at assessing the impact of anti-CGRP therapies on the frequency, duration, and characteristics of aura are necessary. Such research could help elucidate the complex relationship between CGRP and aura.