Neurology
CGRP inhibitors for migraine associated with reduced glaucoma risk
Clinical takeaway: CGRP monoclonal antibodies do not appear to increase glaucoma risk and may be associated with a lower risk, but they should not be used for glaucoma prevention.
Migraine is associated with an increased risk of glaucoma, a leading cause of irreversible blindness. New data suggest that certain migraine‑preventive drugs—specifically calcitonin gene‑related peptide (CGRP) monoclonal antibodies—may be associated with a lower risk of developing glaucoma.
In a large observational study, investigators compared 36,822 people treated with CGRP inhibitor drugs for migraine prevention with an equal number of patients using other established migraine preventives. Participants were newly prescribed therapy, had at least one refill, and were followed for up to three years to assess incident glaucoma.
During follow‑up, 0.42% of patients in the CGRP inhibitor group developed glaucoma compared with 0.61% of those receiving non‑CGRP migraine preventives. After adjustment for age, migraine frequency, hypertension, and other potential confounders, CGRP inhibitor use was associated with a 25% lower relative risk of glaucoma.
Importantly, the signal was confined to CGRP monoclonal antibodies—erenumab, fremanezumab, galcanezumab, and eptinezumab. No reduction in glaucoma risk was observed with oral CGRP receptor antagonists (gepants), including atogepant and rimegepant. Comparator drugs included commonly used migraine preventives such as topiramate, valproate, beta‑blockers, ACE inhibitors, antidepressants, and flunarizine.
The biologic rationale remains speculative. Migraine and glaucoma are both linked to vascular dysregulation, and CGRP plays a role in vascular tone and neurogenic inflammation. By modulating vascular reactivity, monoclonal antibody CGRP inhibitors may have downstream effects relevant to optic nerve health, the authors note.
The researchers emphasized that the findings do not establish causality and should not be interpreted as evidence that CGRP inhibitors prevent glaucoma. Limitations included the inability to account for family history of glaucoma and other unmeasured risk factors.
“Further studies are needed to confirm these results, but the findings may help us better understand both migraine and glaucoma,” said study author Chien-Hsiang Weng, MD, MPH, of Brown University.
Source: Weng CH, et al. (2026, May 6). Neurology. Glaucoma risk associated with calcitonin gene–related peptide inhibitor use in migraine