"Mom, another headache? Go to the hospital and try the shot."
"Is it OK for someone my age to get such an expensive injection?"
Many older adults with migraines face exactly these questions. Already taking multiple medications for conditions such as high blood pressure and diabetes, they worry about whether adding a new drug is safe—and whether it will actually help. Researchers in South Korea have now addressed those concerns using real-world clinical data.
After a year, headaches clearly eased for 7 out of 10 patients
A joint research team from nine university hospitals in South Korea tracked and analyzed 107 migraine patients ages 65 and older who received calcitonin gene-related peptide (CGRP) monoclonal antibody treatment from January 2022 to April 2025. Patients received one of two therapies: galcanezumab (brand name Emgality) or fremanezumab (brand name Ajovy). The findings were published in the June 5 issue of 〈The Journal of Headache and Pain〉, an international journal focused on headache and pain.
Among patients who stayed on treatment consistently, the share whose monthly headache days fell by at least half increased over time: 48.2% at three months, 67.9% at six months and 70.4% at 12 months. In other words, headaches clearly decreased for 7 out of 10 patients who reached one year of treatment. Even when the analysis included all patients, including those who stopped treatment partway through, the benefit persisted: 38.8% at three months and 40.9% at six months.
Is it safe to use with blood pressure and diabetes drugs?
Safety is as important as effectiveness, particularly for older patients who may be taking several medications. Adding a migraine injection on top of blood pressure and diabetes drugs can raise concerns about drug interactions and overall strain on the body.
During the observation period, one patient died, but investigators confirmed the death was unrelated to the study drug. No other serious adverse reactions were reported. Side effects were limited to mild symptoms such as constipation or itching at the injection site.
Cho Soo-hyun, a professor of neurology at Uijeongbu Eulji University Hospital, said, "Older migraine patients often have chronic conditions such as hypertension or diabetes, and it is also common for them to take multiple medications, which has made it difficult to choose preventive treatment." Cho said the study matters because it confirms, using real-world clinical data, that CGRP monoclonal antibodies can be an effective and safe preventive option even for older migraine patients.
Why did it take so long to get an answer?
So why has evidence like this been scarce? Most pivotal clinical trials for CGRP monoclonal antibodies enrolled people under 65. Older patients often have complex comorbidities and take many medications, which limited their participation in clinical trials and left a data gap.
Outside South Korea, researchers have already tried to close that gap.
A study across 18 headache clinics in Spain, published in 2023 in 〈The Journal of Headache and Pain〉, analyzed 162 people ages 65 and older and found that by six months, monthly migraine days had fallen by an average of more than 10 days, while adverse reactions were mostly mild. A research team at the Cleveland Clinic in the United States also reported in the 2025 issue of the neurology clinical journal 〈Neurology Clinical Practice〉 that when it compared patients ages 65 and older with those under 65, there were no differences in effectiveness or side effects.
Those studies focused on Western patients, and many did not follow participants for more than six months. This is the first real-world dataset to track older Korean patients for at least one year across nine hospitals.
Who responds better—and who responds less?
The research team also analyzed factors linked to treatment response.
Female patients showed a better treatment response. By contrast, patients who had previously failed botulinum toxin treatment tended to have a lower response to CGRP antibodies as well.
That pattern suggests that as treatment failures accumulate, the next options narrow. It also supports starting preventive migraine treatment as early as possible.
Cho said, "Given that a substantial number of patients who continued treatment saw their headache days drop by at least half, we expect these findings will serve as important evidence for improving quality of life among older migraine patients and for establishing personalized treatment strategies going forward."
Still, because this was an observational study, it is difficult to draw firm conclusions about causality. And with only 107 patients, additional large-scale studies are needed.
