GLP-1 Receptor Agonists Associated with Reduced Acute Care Use and Treatment Escalation in Chronic Migraine
KEY TAKEAWAYS
- GLP-1 RA use was associated lower rates of ED visits, hospitalizations, and acute migraine treatment compared with topiramate.
- Initiation of additional preventive therapies—including TCAs, SNRIs, valproate, gepants, and CGRP monoclonal antibodies—was also reduced.
- Findings from this real-world analysis support further prospective studies to evaluate GLP-1 RAs as potential migraine therapies.
Treatment with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) was associated with fewer emergency department (ED) visits, hospitalizations, and initiation of additional preventive therapies compared with Topamax (topiramate; Janssen Pharmaceuticals, Titusville, NJ) treatment in adults with chronic migraine (CM). These real-world findings, presented at the 2026 American Academy of Neurology (AAN) Annual Meeting, suggest a potential role for GLP-1 RAs—agents widely used for metabolic disorders—in migraine management.
Researchers conducted a real-world, active-comparator cohort study using the TriNetX (Cambridge, MA) database. Adults with CM who initiated a GLP-1 RA (liraglutide, semaglutide, dulaglutide, exenatide, lixisenatide, or albiglutide) within 12 months of a recorded diagnosis were compared with Topamax initiators. After 1:1 propensity-score matching for demographics, body mass index (BMI), comorbidities, and prior preventive use, approximately 11,000 individuals per cohort were analyzed (mean age, 48 years; 87.8% female). Outcomes over 12 months included ED visits, hospitalizations, nerve-block procedures, triptan use, and initiation of new preventive therapies, including tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), Depakote (valproate; AbbVie, Chicago, IL), calcitonin gene-related peptide (CGRP) antagonists, and CGRP monoclonal antibodies (mAbs).
Key Findings
- Acute-care utilization was lower in the GLP-1 RA cohort compared with Topamax: ED visits (risk ratio [RR], 0.90; 95% CI, 0.86 to 0.94), hospitalizations (RR, 0.86; 95% CI, 0.81 to 0.91), nerve-block procedures (RR, 0.87; 95% CI, 0.78 to 0.97), and triptan use (RR, 0.87; 95% CI, 0.84 to 0.91).
- Escalation to additional preventive therapies was lower in the GLP-1 RA cohort compared with Topamax: TCAs (RR, 0.65; 95% CI, 0.55 to 0.77), SNRIs (RR, 0.80; 95% CI, 0.64 to 0.995), Depakote (RR, 0.52; 95% CI, 0.40 to 0.68), gepants (RR, 0.77; 95% CI, 0.69 to 0.85), and CGRP mAbs (RR, 0.58; 95% CI, 0.52 to 0.65); there was no significant difference in beta-blocker initiation.
Source
Acar V, Franco M, Wang V, et al. GLP-1 receptor agonists and chronic migraine: a real-world cohort study of healthcare utilization and preventive escalation. Presented at: American Academy of Neurology Annual Meeting; April 18-22, 2026; Chicago, IL.