{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T15:02:29Z","timestamp":1789398149653,"version":"build-2803163510"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Calcitonin gene-related peptide (CGRP)-targeting therapies have transformed migraine management and are generally associated with a favorable safety profile. However, accumulating real-world evidence suggests a potential association with alopecia that was not systematically captured in pre-approval clinical trials. This review aimed to synthesize current evidence on alopecia associated with CGRP-targeting therapies, with a focus on clinical patterns, pharmacovigilance signals and underlying pathophysiological mechanisms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A structured literature search of PubMed was conducted to identify relevant evidence on CGRP-targeting therapies and hair loss through August, 2026. Eligible studies included clinical trials, observational studies, pharmacovigilance analyses and case reports reporting alopecia outcomes. Reference lists were screened for additional relevant studies. Due to heterogeneity of study designs and predominance of low-level evidence, findings were synthesized narratively without formal quality assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Evidence from pharmacovigilance data and case-based observations suggests a reproducible signal of predominantly reversible, non-scarring alopecia occurring within weeks to months after initiation of CGRP-targeting therapies. Reports span multiple monoclonal antibodies and gepants, supporting a potential class effect. However, the available evidence is largely derived from spontaneous reporting systems and case series, limiting causal inference and precluding reliable estimation of incidence. Proposed mechanisms include neuroimmune dysregulation, impairment of hair follicle immune privilege, reduced microvascular perfusion, and disruption of the CGRP-insulin-like growth factor-1 axis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Alopecia has emerged as a potentially clinically relevant safety signal associated with CGRP-targeting therapies. Although the association is biologically plausible, the available evidence does not establish causality, frequency or the typical clinical course of this adverse event. Most cases appear to be mild, non-scarring and reversible. Given the expanding use of these therapies, increased clinical awareness and individualized management are essential. Future prospective studies with standardized dermatological assessment are needed to better define incidence, risk factors and underlying mechanisms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1949826","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T14:03:22Z","timestamp":1789394602000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hair loss in the era of CGRP inhibition: emerging evidence, mechanisms, and clinical implications"],"prefix":"10.3389","volume":"17","author":[{"given":"Adel\u0117","family":"Antanaityt\u0117","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Vilnius University","place":["Vilnius, Lithuania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mantas","family":"Jokubaitis","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Vilnius University","place":["Vilnius, Lithuania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorinta","family":"Jokubait\u0117","sequence":"additional","affiliation":[{"name":"Centre of Dermatovenerology, Vilnius University Hospital Santaros Klinikos","place":["Vilnius, Lithuania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Ryli\u0161kien\u0117","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Vilnius University, Institute of Clinical Medicine, Clinic of Neurology and Neurosurgery","place":["Vilnius, Lithuania"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1565","DOI":"10.1152\/physrev.00059.2021","article-title":"CGRP physiology, pharmacology, and therapeutic targets: migraine and beyond","volume":"103","author":"Russo","year":"2023","journal-title":"Physiol Rev"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"40","DOI":"10.18773\/austprescr.2025.017","article-title":"Calcitonin gene-related peptide\u2013targeted therapies for migraine","volume":"48","author":"Barnes","year":"2025","journal-title":"Aust Prescr"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"3331024231152169","DOI":"10.1177\/03331024231152169","article-title":"Safety and tolerability of monoclonal antibodies targeting the CGRP pathway and gepants in migraine prevention: a systematic review and network meta-analysis","volume":"43","author":"Messina","year":"2023","journal-title":"Cephalalgia"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1257282","DOI":"10.3389\/fphar.2023.1257282","article-title":"Adverse event reporting of four anti-calcitonin gene-related peptide monoclonal antibodies for migraine prevention: a real-world study based on the FDA adverse event reporting system","volume":"14","author":"Sun","year":"2024","journal-title":"Front Pharmacol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1143538","DOI":"10.1177\/03331024221143538","article-title":"Alopecia as an emerging adverse event to CGRP monoclonal antibodies: cases series, evaluation of FAERS, and literature review","volume":"43","author":"Ruiz","year":"2023","journal-title":"Cephalalgia"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1002\/phar.2725","article-title":"Alopecia signals associated with calcitonin gene-related peptide inhibitors in the treatment or prophylaxis of migraine: a pharmacovigilance study","volume":"42","author":"Woods","year":"2022","journal-title":"Pharmacotherapy"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1431562","DOI":"10.3389\/fphar.2024.1431562","article-title":"Real-world study of adverse events associated with gepant use in migraine treatment based on the VigiAccess and U.S. Food and Drug Administration\u2019s adverse event reporting system databases","volume":"15","author":"Liang","year":"2024","journal-title":"Front Pharmacol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"100361","DOI":"10.1016\/j.bbih.2021.100361","article-title":"Roles of calcitonin gene-related peptide in the skin, and other physiological and pathophysiological functions","volume":"18","author":"Kim","year":"2021","journal-title":"Brain Behav Immun Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"13979","DOI":"10.3390\/ijms241813979","article-title":"Calcitonin gene-related peptide systemic effects: embracing the complexity of its biological roles-a narrative review","volume":"24","author":"Bonura","year":"2023","journal-title":"Int J Mol Sci"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"118","DOI":"10.61705\/jdcr.18.1.2025.118.128","article-title":"Systematic review: causes and treatments of hair loss","volume":"18","author":"Sankhwar","year":"2025","journal-title":"J Dermatol Case Rep"},{"key":"ref11","first-page":"15","article-title":"Androgenetic alopecia","volume":"149","author":"Piraccini","year":"2014","journal-title":"G Ital Dermatol Venereol"},{"key":"ref12","volume-title":"StatPearls","author":"Hughes","year":"2026"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"700","DOI":"10.47102\/annals-acadmedsg.2024138","article-title":"Traction alopecia in women: an under-recognised cause of hair loss","volume":"53","author":"Lua","year":"2024","journal-title":"Ann Acad Med Singap"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1111\/head.14427","article-title":"Effluvium and alopecia associated with monoclonal calcitonin gene-related peptide antibody use","volume":"63","author":"Evers","year":"2023","journal-title":"Headache"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/S1474-4422(16)30293-9","article-title":"Sex differences in the epidemiology, clinical features, and pathophysiology of migraine","volume":"16","author":"Vetvik","year":"2017","journal-title":"Lancet Neurol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/14740338.2025.2497394","article-title":"Identifying signals of disproportionate reporting for calcitonin gene-related peptide inhibitors: real-world evidence from the FDA adverse event reporting system","volume":"1","author":"Lee","year":"2025","journal-title":"Expert Opin Drug Saf"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1186\/s10194-023-01644-8","article-title":"Mode and site of action of therapies targeting CGRP signaling","volume":"24","author":"Labastida-Ram\u00edrez","year":"2023","journal-title":"J Headache Pain"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1111\/j.1600-0625.2011.01432.x","article-title":"Calcitonin gene-related peptide (CGRP) may award relative protection from interferon-\u03b3-induced collapse of human hair follicle immune privilege","volume":"21","author":"Kinori","year":"2012","journal-title":"Exp Dermatol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/j.npep.2012.07.008","article-title":"Effects of calcitonin gene-related peptide on the immune privilege of human hair follicles","volume":"47","author":"Pi","year":"2013","journal-title":"Neuropeptides"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1492","DOI":"10.3389\/fimmu.2025.1621492","article-title":"From mechanisms to therapies: current advances breakthroughs in alopecia areata immunopathology","volume":"16","author":"Zhao","year":"2025","journal-title":"Front Immunol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1186\/s10194-021-01330-7","article-title":"Inflammatory complications of CGRP monoclonal antibodies: a case series","volume":"22","author":"Ray","year":"2021","journal-title":"J Headache Pain"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1016\/j.ghir.2011.07.003","article-title":"Dihydrotestosterone inhibits hair growth in mice by inhibiting insulin-like growth factor-I production in dermal papillae","volume":"21","author":"Zhao","year":"2011","journal-title":"Growth Hormon IGF Res"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"3469","DOI":"10.3390\/jcm14103469","article-title":"Assessment of vascular circulation in alopecia Areata using the FMSF technique","volume":"14","author":"Wo\u017aniacka","year":"2025","journal-title":"J Clin Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e260741","DOI":"10.1136\/bcr-2024-260741","article-title":"Fremanezumab-associated injection site alopecia","volume":"17","author":"Esguerra","year":"2024","journal-title":"BMJ Case Rep CP"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"773","DOI":"10.3390\/cimb47090773","article-title":"Insulin-like growth factor 1 (IGF-1) in hair regeneration: mechanistic pathways and therapeutic potential","volume":"47","author":"Hsieh","year":"2025","journal-title":"Curr Issues Mol Biol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1016\/j.jnutbio.2010.01.008","article-title":"Dietary isoflavone increases insulin-like growth factor-I production, thereby promoting hair growth in mice","volume":"22","author":"Zhao","year":"2011","journal-title":"J Nutr Biochem"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"26","DOI":"10.5021\/ad.2012.24.1.26","article-title":"Effect of IGF-I on hair growth is related to the anti-apoptotic effect of IGF-I and up-regulation of PDGF-A and PDGF-B","volume":"24","author":"Ahn","year":"2012","journal-title":"Ann Dermatol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1007\/s40259-021-00469-8","article-title":"New insight on the safety of Erenumab: an analysis of spontaneous reports of adverse events recorded in the US Food and Drug Administration adverse event reporting system database","volume":"35","author":"Sessa","year":"2021","journal-title":"BioDrugs"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1896","DOI":"10.1080\/09546634.2021.1945527","article-title":"Minoxidil: a comprehensive review","volume":"33","author":"Gupta","year":"2022","journal-title":"J Dermatolog Treat"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1805","DOI":"10.3390\/jcm14061805","article-title":"Characterization and Management of Adverse Events of low-dose Oral Minoxidil treatment for alopecia: a narrative review","volume":"14","author":"Jimenez-Cauhe","year":"2025","journal-title":"J Clin Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1111\/jocd.16086","article-title":"Clinical efficacy and safety of low-dose oral minoxidil versus topical solution in the improvement of androgenetic alopecia: a randomized controlled trial","volume":"23","author":"Asilian","year":"2024","journal-title":"J Cosmet Dermatol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1485","DOI":"10.1111\/jdv.17216","article-title":"Review of oral minoxidil as treatment of hair disorders: in search of the perfect dose","volume":"35","author":"Villani","year":"2021","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1016\/j.jaad.2025.04.016","article-title":"Summation and recommendations for the safe and effective use of topical and oral minoxidil","volume":"93","author":"Olsen","year":"2025","journal-title":"J Am Acad Dermatol"},{"key":"ref34","volume-title":"StatPearls","author":"Patel","year":"2026"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1016\/j.jaad.2003.06.014","article-title":"A randomized, placebo-controlled trial of 5 and 2% topical minoxidil solutions in the treatment of female pattern hair loss","volume":"50","author":"Lucky","year":"2004","journal-title":"J Am Acad Dermatol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1055\/s-0041-1739254","article-title":"Pharmacological Management of Pattern Hair Loss","volume":"54","author":"Sattur","year":"2021","journal-title":"Indian J Plast Surg"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"3","DOI":"10.4103\/ijt.ijt_28_21","article-title":"An updated review on current treatment of alopecia Areata and newer therapeutic options","volume":"15","author":"Malhotra","year":"2023","journal-title":"Int J Trichology"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1007\/s13555-018-0278-6","article-title":"The role of vitamins and minerals in hair loss: a review","volume":"9","author":"Almohanna","year":"2018","journal-title":"Dermatol Ther (Heidelb)"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"137","DOI":"10.2147\/CCID.S291170","article-title":"The diagnostic value of serum ferritin for Telogen effluvium: a cross-sectional comparative study","volume":"14","author":"Cheng","year":"2021","journal-title":"Clin Cosmet Investig Dermatol"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1186\/s10194-023-01680-4","article-title":"One-year prospective real-world assessment of effectiveness and safety of erenumab in migraine prevention: results of the French FHU INOVPAIN registry study","volume":"24","author":"Lanteri-Minet","year":"2023","journal-title":"J Headache Pain"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1435","DOI":"10.1111\/ene.15740","article-title":"Efficacy and safety of fremanezumab for migraine prophylaxis in patients with at least three previous preventive failures: prospective, multicenter, real-world data from a Greek registry","volume":"30","author":"Argyriou","year":"2023","journal-title":"Eur J Neurol"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1016\/j.jaad.2023.03.057","article-title":"Medications affecting the insulin-like growth factor 1\/growth hormone axis, including teprotumumab, somatostatin analogs, and anti-calcitonin gene-related peptide monoclonal antibodies, are associated with elevated reporting odds of alopecia in women: a pharmacovigilance study","volume":"89","author":"Jedlowski","year":"2023","journal-title":"J Am Acad Dermatol"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1949826\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T14:03:23Z","timestamp":1789394603000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1949826\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,14]]},"references-count":42,"alternative-id":["10.3389\/fneur.2026.1949826"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1949826","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,14]]},"article-number":"1949826"}}