Migraine-related stigma is a pervasive issue impacting nearly half of chronic migraine patients, with significant consequences for their quality of life, disability and mental health. Despite its profound effects, migraine stigma remains under-recognised in both clinical practice and research. This narrative review explores the three primary types of stigmas affecting migraine patients: public, structural and internalised. Public stigma involves negative societal attitudes and stereotypes that trivialise the condition. Structural stigma is reflected in policies that restrict access to necessary care and resources. Internalised stigma occurs when patients absorb these negative views, leading to self-blame and diminished self-worth. Addressing these different types of stigmas is crucial for improving the understanding, diagnosis and treatment of migraine. Educational efforts, advocacy and policy reform are essential strategies in this context. A deep understanding of stigma is vital for developing effective interventions that enhance clinical management and patient quality of life. Ultimately, reducing stigma can lead to better health outcomes and a more comprehensive approach to migraine care.

Background: Preclinical evidence supports the immunoregulatory role of calcitonin gene-related peptide (CGRP) in migraine pathophysiology. The increasing use of anti-CGRP therapies in patients with migraine and other comorbidities raises the question whether the potential use of anti-CGRP monoclonal antibodies (CGRP-mAbs) therapies in combination with other immunological therapies is effective and safe. Methods: This multicenter study included patients with migraine receiving CGRP-mAbs combined with immunosuppressive and immunomodulatory treatments. Clinical and demographic data, treatment history, laboratory markers and treatment-emergent adverse events (TEAEs) were analyzed. Effectiveness outcomes included the change in monthly migraine days (MMD) and monthly headache days (MHD) at 3, 6, 9 and 12 months, alongside the > 50% response rate. Moreover, autoimmune disease progression was also evaluated. We explored differences between patients with and without autoimmune disease activation. Results: Among 89 patients, there were 80 (90%) females with a mean age of 50 years (SD: 11), who had a high prevalence of psychiatric comorbidities (anxiety 44%, depression 49%) and medication overuse (68%). Patients receiving immunological treatments experienced significant reductions in MMD and MHD, with MMD decreasing from 16 (SD: 7) at baseline to 9 (SD: 8) at 6 months, and MHD dropping from 23 (SD: 8) to 17 (SD: 11). A 50% response in MMD was achieved by 46% at 6 months. TEAEs were reported in 28%, most commonly constipation (16%) and dizziness (9%). Conclusions: CGRP-mAbs therapies combined with immunological treatments appear effective and safe in patients with autoimmune diseases. Larger prospective studies are necessary to confirm these findings and optimize management strategies.

Chronic migraine (CM) causes great disability and affects an individual's quality of life. OnabotulinumtoxinA (OBT-A, Botox®) was the first prophylactic treatment specifically indicated for CM. The aim of this study was to describe the experiences of women with CM treated with OBT-A. The study design is a qualitative descriptive study. A purposeful sampling of 30 women (mean age, 42.7; standard deviation, 10.6) who had received at least two administrations of OBT-A for CM (PREEMPT protocol) was performed. Data collection included in-depth interviews and researchers' field notes. A thematic analysis was carried out according to qualitative research guidelines. Five themes were identified: (a) A long way to go before Botox®, (b) First time hearing about the treatment and its expectations, (c) The administration of Botox®, (d) Treatment effects, and (e) Follow-up. Patients described a long history of treatment failures prior to the start of OBT-A treatment. Information about this migraine treatment came from the neurologist; following the information, patients had high expectations, including unrealistic expectations regarding the onset and duration of effect. They acknowledged fear of the injections and some discomfort due to the procedure. With treatment, participants reported better migraine control and an improvement in their quality of life. Follow-up had some barriers, such as delayed appointments for subsequent doses, but also strengths, such as effectiveness and few side effects. Qualitative research offers insight into how patients with CM experience treatment with OBT-A. Our results highlight some relevant aspects that should be considered when providing OBT-A treatment.

Objective: This study aimed to evaluate demographic characteristics, treatment effectiveness, and safety outcomes in patients with migraine undergoing anti‐calcitonin gene‐related peptide (CGRP) treatments regarding the presence of autoimmune diseases. Background: CGRP has an important role in migraine pathophysiology through neuronal modulation in the trigeminovascular nociceptive system and activation of neuro‐inflammatory cascades. We hypothesized that autoimmune diseases may influence treatment response and safety profiles in patients with migraine treated with anti‐CGRP treatments. Methods: This was a retrospective multicenter, age‐ and sex‐matched cohort study in headache units/headache clinics in Spain and United Kingdom between May 2024 and May 2025 including patients treated with CGRP monoclonal antibodies from prospectively collected cohorts. Patients were assessed for demographics, migraine‐related characteristics, treatment effectiveness (monthly migraine days [MMD] and/or monthly headache days [MHD]), and safety outcomes. The main outcome was the effectiveness measured by ≥50% response rate in MMD between the two groups. Secondary outcomes included other effectiveness measurements regarding the number of MMD and MHD and treatment emerging adverse events. Results: A total of 388 patients with migraine under anti‐CGRP treatments (194 with autoimmune diseases and 194 age‐ and sex‐matched controls without autoimmune diseases) were included. The proportion of patients achieving a ≥50% response rate in MMD was higher in patients without autoimmune diseases at 6 (69% vs. 53%; p = 0.006) and 9 months (74% vs. 52%; p = 0.006). Treatment emerging adverse events were comparable between the two groups (35% vs. 38%; p = 0.575). Patients with autoimmune disease had a significantly lower likelihood of achieving a ≥50% response in MMD compared with those without autoimmune disease (adjusted odds ratio, 0.61; 95% confidence interval, 0.44–0.85; p = 0.006), independent of comorbid depression and medication overuse. Conclusions: Our study shows that anti‐CGRP treatments are effective and safe for patients with migraine regardless the presence of autoimmune diseases, although an increased treatment response in patient without autoimmune disorders compared to patients with autoimmune disorders was observed. These findings highlight the need for early intervention, tailored strategies, and vigilant monitoring in patients with migraine and autoimmune disorders. Further research should explore immunomodulatory approaches to enhance outcomes. image

Several factors contribute to stigma associated with migraine, such as the lack of objective diagnostic tests and biomarkers or traditional gender stereotypes. Patients with migraine can perceive the stigma from different sources: other people (public stigma), organisations (structural stigma) or themselves (internalised stigma), and even neurologists may harbour stigma towards patients with headache. At a social level, repeated migraine attacks lead to restricted participation in work and family life, inducing anxiety, depression and reduced self-esteem. Regarding the workplace, the impact of migraine on their proffesional lives is significant. Individuals who were acquainted with people with migraine at job tended to behave more negatively towards them, and over half of the managers did not consider headache as a valid reason for being absent from work. Effectiveness at work is reduced during a migraine attack, but also because of the interictal symptoms these patients go through. Regarding presenteeism, migraine was the second most expensive disease in the USA, with an annual cost of approximately $240 billion. For all these facts, destigmatisation should take place at the level of healthcare providers, patients and the general population. Implementing educational programmes, training more neurologists in a specialised headache approach, listening to the patients and taking their concerns seriously, or recognizing the disability that the disease causes are strategies that may help minimizing the stigma of migraine.

Background: Short- and mid-term real-world data support the effectiveness of atogepant for migraine prevention, but evidence beyond 6 months remains scarce. This study evaluated the 12-month effectiveness, safety, persistence, and predictors of response in a large treatment-resistant migraine cohort. Methods: This prospective multicentre study enrolled patients from 15 tertiary Headache Units in Spain within the GEMA Project. Clinical and demographic characteristics, previous and concomitant preventive treatments, monthly headache days (MHD), monthly migraine days (MMD), and adverse events were systematically collected at baseline and after 3, 6, and 12 months. In a subset of patients, Headache Impact Test (HIT-6), Hospital Anxiety and Depression Scale (HADS), and Insomnia Severity Index (ISI) were also assessed. Results: A total of 513 patients were included. The cohort showed marked treatment resistance, with a median of 6 previous preventive failures; 74% ( n = 380) had chronic migraine, 84% ( n = 423) had previously failed onabotulinumtoxinA, and more than half had prior exposure to anti-CGRP monoclonal antibodies ( n = 270). Treatment persistence was approximately 80% at 6 months ( n = 409) and 60% at 12 months ( n = 304), with lack of effectiveness as the main reason for discontinuation. Among patients remaining on treatment with complete data at all follow-up visits, median MHD decreased from 20 days at baseline to 10 days at 3 months and 9 days at 6 months, remaining stable at 9 days at 12 months. Median MMD decreased from 13 days to 6 days at 3 months, 5 days at 6 months, and remained at 5 days at 12 months ( p < 0.0001 versus baseline for all time points). At 12 months, ≥ 50% response rates were 52.3% for MHD and 57.8% for MMD in the observed-case analysis, and approximately 31% and 33%, respectively, using non-responder imputation in the full baseline cohort. Improvements in disability and medication overuse were observed, while exploratory analyses in smaller subsets suggested improvements in anxiety, depression, and insomnia. A greater burden of previous preventive treatment failures independently predicted lower odds of achieving a ≥ 50% response at 12 months. The frequency of most reported adverse events was lower at later follow-up visits, and no new safety signals emerged. Conclusions: Atogepant was associated with maintained clinical benefit over 12 months among patients who remained on treatment, with a favourable long-term safety profile in a highly treatment-resistant migraine population. Greater previous preventive failure burden predicted lower response rates, reinforcing the importance of earlier preventive optimisation. Trial registration: ClinicalTrials.gov, NCT07699549, retrospectively registered on 8th of July 2026.