Table 9 Summary of the expert consensus statements

1. When should treatment with monoclonal antibodies targeting the CGRP pathway be offered to individuals with migraine?

In individuals with migraine who require preventive treatment, we suggest monoclonal antibodies targeting the CGRP pathway to be included as a first line treatment option.

2. How should other preventive treatments be managed when using monoclonal antibodies targeting the CGRP pathway in individuals with migraine?

In individuals with episodic or chronic migraine there is insufficient evidence to make suggestions regarding the combination of monoclonal antibodies targeting the CGRP with other preventatives to improve migraine clinical outcomes

3. When should treatment efficacy in individuals with migraine on treatment with anti-CGRP monoclonal antibodies be firstly evaluated?

In individuals with episodic or chronic migraine who start a new treatment with one monoclonal antibody targeting the CGRP pathway we suggest evaluating efficacy after a minimum of 3 consecutive months on treatment

4. When should treatment with anti-CGRP monoclonal antibodies be paused in individuals with migraine?

In individuals with episodic or chronic migraine we suggest considering a pause in the treatment with monoclonal antibodies targeting the CGRP pathway after 12-18 months of continuous treatment. If deemed necessary, treatment should be continued as long as needed. In individuals with migraine who pause treatment, we suggest restarting the treatment if migraine worsens after treatment withdrawal.

5. Should individuals with migraine and medication overuse offered treatment with monoclonal antibodies targeting the CGRP pathway?

In individuals with migraine and medication overuse, we suggest offering monoclonal antibodies targeting the CGRP pathway.

6. In individuals with migraine who are non-responders to one monoclonal antibody targeting the CGRP pathway, is switching to a different antibody an option?

In individuals with migraine with inadequate response to one monoclonal antibody targeting the CGRP pathway, there is insufficient evidence on the potential benefits of antibody switch but switching may be an option.

7. In which individuals with migraine is caution suggested when considering treatment with monoclonal antibodies targeting the CGRP pathway?

We suggest avoiding monoclonal antibodies targeting the CGRP pathway in pregnant or nursing women. We suggest caution and decision on a case-by-case basis in the presence of vascular disease or risk factors and Raynaud phenomenon. We suggest caution in erenumab use in individuals with migraine with history of severe constipation.