{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T22:55:52Z","timestamp":1791327352582,"version":"4.3.1"},"reference-count":39,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Chronic migraine (CM) is often complicated by medication-overuse headache (MOH), worsening disability. Although withdrawal of overused medications is recommended, adherence is poor and relapse is frequent. Monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway may offer an effective preventive option without requiring discontinuation, but current evidence is limited by few and heterogeneous randomized controlled trials (RCTs).<\/jats:p>\n                  <jats:p>To systematically assess the efficacy and safety of anti-CGRP mAbs in treating CM with MOH (CM\u2009+\u2009MOH) under a conservative approach.<\/jats:p>\n                  <jats:p>The PubMed, Embase, and Cochrane Central databases were searched for RCTs comparing anti-CGRP mAbs with placebo in adults with CM\u2009+\u2009MOH. The primary outcome was the mean change in monthly migraine days (MMDs) at 3 months. The secondary outcomes included acute medication use, disability, drug overuse resolution, response rate, and adverse events (AEs). Random-effects models with Sidik-Jonkman estimator and Knapp-Hartung adjustments pooled effect sizes.<\/jats:p>\n                  <jats:p>We included seven RCTs, totalling 3,094 patients. Anti-CGRP mAbs significantly reduced MMDs (mean difference [MD]\u2009=\u2009-0.35; 95%CI: -0.43 to -0.26) and acute medication use (MD\u2009=\u2009-0.35; 95%CI: -0.51 to -0.19) compared with placebo. Higher rates, of \u2265 50%, of response (risk ratio [RR]\u2009=\u20091.94; 95%CI: 1.60\u20132.34) and drug overuse resolution (RR\u2009=\u20091.38; 95%CI: 1.04\u20131.83) were observed, with no significant increase in AEs (RR\u2009=\u20091.09; 95%CI: 0.85\u20131.40).<\/jats:p>\n                  <jats:p>Anti-CGRP mAbs were effective and well tolerated in CM\u2009+\u2009MOH, representing a viable alternative, especially for patients unable to discontinue acute medications. Further research should assess long-term outcomes and subgroup effects.<\/jats:p>","DOI":"10.1055\/s-0046-1817018","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T01:28:02Z","timestamp":1772242082000},"page":"001-009","source":"Crossref","is-referenced-by-count":2,"title":["Anti-CGRP monoclonal antibodies for chronic migraine with medication-overuse headache: a conservative meta-analysis"],"prefix":"10.1055","volume":"84","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8728-1411","authenticated-orcid":false,"given":"Luana Miyahira","family":"Makita","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Setor de Ci\u00eancias da Sa\u00fade, Departamento de Medicina, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9247-0146","authenticated-orcid":false,"given":"Gabriela das Gra\u00e7as dos Santos","family":"Carolino","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias M\u00e9dicas e da Sa\u00fade de Juiz de Fora, Departamento de Medicina, Juiz de Fora MG, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5816-817X","authenticated-orcid":false,"given":"Yuri Gubitose de","family":"Souza","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina do ABC, Departamento de Medicina, Santo Andr\u00e9 SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2624-3486","authenticated-orcid":false,"given":"Helo\u00edsa Carneiro","family":"Brito","sequence":"additional","affiliation":[{"name":"Universidade Federal da Para\u00edba, Departamento de Medicina, Jo\u00e3o Pessoa PB, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9452-4216","authenticated-orcid":false,"given":"Mariana","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Faculdade de Ensino Superior da Amaz\u00f4nia Reunida, Departamento de Medicina, Reden\u00e7\u00e3o PA, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4719-2195","authenticated-orcid":false,"given":"Giovana Schlichta Adriano","family":"Kojima","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Setor de Ci\u00eancias da Sa\u00fade, Departamento de Medicina, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9381-0684","authenticated-orcid":false,"given":"Milena Ramos","family":"Tom\u00e9","sequence":"additional","affiliation":[{"name":"Universidade Federal de Campina Grande, Cajazeiras PB, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7187-8267","authenticated-orcid":false,"given":"J\u00falia dos Santos","family":"Monteiro","sequence":"additional","affiliation":[{"name":"Universidade de Pernambuco, Recife PE, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0807-9060","authenticated-orcid":false,"given":"Yasmin Bastos","family":"Faller","sequence":"additional","affiliation":[{"name":"Universidad de Buenos Aires, Departamento de Medicina, Buenos Aires, Argentina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0915-0430","authenticated-orcid":false,"given":"Elcio Juliato","family":"Piovesan","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Departamento de Cl\u00ednica M\u00e9dica, Disciplina de Neurologia, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0068-1905","authenticated-orcid":false,"given":"Mario Fernando Prieto","family":"Peres","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Hospital das Cl\u00ednicas, Departamento de Psiquiatria, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/S1474-4422(24)00038-3","article-title":"Global, regional, and national burden of disorders affecting the nervous system, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021","volume":"23","author":"GBD 2021 Nervous System Disorders Collaborators","year":"2024","journal-title":"Lancet 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Sirilertmekasakul","year":"2024","journal-title":"Neurol Sci"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/1471-2288-14-25","article-title":"The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method","volume":"14","author":"J IntHout","year":"2014","journal-title":"BMC Med Res Methodol"},{"issue":"07","key":"ref27","doi-asserted-by":"publisher","first-page":"1102","DOI":"10.1111\/ene.14268","article-title":"European Academy of Neurology guideline on the management of medication-overuse headache","volume":"27","author":"H C Diener","year":"2020","journal-title":"Eur J Neurol"},{"issue":"01","key":"ref28","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1186\/s10194-024-01813-3","article-title":"Persistent effectiveness of CGRP antibody therapy in migraine and comorbid medication overuse or medication overuse headache - a retrospective 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