- The Impact of Anti-Calcitonin Gene-Related Peptide Monoclonal Antibodies on Sleep Quality and Daytime Sleepiness in Migraine Patients: A Multicenter Study
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Rita Cagigal, Ângelo Fonseca, Bárbara Martins, Catarina Fernandes, Sandra Palma, Carolina Guerreiro, Carla Morgado, Diana Valente, Miguel Miranda, Joana Silva, Miguel Saianda-Duarte, Sofia Casanova, Mariana Branco, Ana Luísa Rocha, Henrique Delgado, Elsa Parreira, Filipe Palavra
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Received October 3, 2025 Accepted November 14, 2025 Published online December 10, 2025
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DOI: https://doi.org/10.62087/hpr.2025.0022
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 Abstract
- Purpose: This study aimed to determine whether patients with migraine experience improvements in self-reported sleep quality and daytime sleepiness after starting monoclonal antibody (mAb) therapy targeting the calcitonin gene-related peptide (CGRP) or its receptor, and to explore the association between treatment efficacy and improvements in sleep quality.
Methods
This prospective, multicenter, observational, longitudinal study was conducted across 12 headache centers. Adults with episodic or chronic migraine who began anti-CGRP mAb therapy were assessed at baseline, 3 months, and 6 months. Sleep quality and daytime sleepiness were evaluated using the Portuguese version of the Pittsburgh Sleep Quality Index (PSQI-PT) and the Portuguese version of the Epworth Sleepiness Scale (ESS-PT), respectively.
Results
Of 118 enrolled patients, 109 completed the study (86.4% female; mean age, 43.6 years). A significant improvement in sleep quality was observed, with median PSQI-PT scores decreasing from 9 at baseline to 6 at 6 months (p<0.001). Daytime sleepiness also improved, with median ESS-PT scores decreasing from 7 to 6 (p=0.04). Migraine frequency decreased significantly, from a median of 13 to 4 monthly migraine days (p<0.001). Greater migraine improvement was independently associated with greater PSQI-PT improvement (p<0.001), whereas changes in ESS-PT were not correlated with treatment efficacy.
Conclusion
Anti-CGRP mAb therapy was associated with significant improvements in sleep quality, likely mediated through migraine relief. Changes in ESS-PT were not correlated with treatment efficacy, suggesting a possible interaction between migraine mechanisms and CGRP-mediated sleep–wake regulation. Future research should focus on clarifying the mechanisms underlying these associations.
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