GLP-1 receptor agonists may have a role in chronic migraine, with a large real-world analysis showing lower healthcare utilization and less need for additional migraine medications over 1 year compared with topiramate. 

“People with chronic migraine often end up in the emergency room or they need to try several preventive medications before finding one that can work for them,” study author Vitoria Acar, MD, with the University of Sao Paulo in Brazil, said in a statement. 

“Seeing these patterns of lower use of emergency care and lower use of drugs to stop migraines, or trying additional drugs to prevent migraines among people taking GLP-1 drugs for other conditions, suggests that these therapies may help stabilize the disease burden in ways that we haven’t fully appreciated yet,” Acar added. 

The findings will be presented at the American Academy of Neurology (AAN) 2026 Annual Meeting in April.

Another Tool in the Toolbox? 

Using the TriNetX database, Acar and colleagues analyzed health record data from roughly 11,000 people with chronic migraine initiating a GLP-1 receptor agonist and a propensity score-matched group of roughly 11,000 initiating topiramate, a drug commonly used to prevent migraine attacks. Participants had a mean age of 48 years and 88% were women. 

The researchers tracked emergency department visits, hospitalizations, nerve block procedures and new prescriptions for medications used to stop or prevent migraine attacks over 12 months. 

They found that those with chronic migraine who started a GLP-1 drug were about 10% less likely to visit the emergency department and 14% less likely to be hospitalized compared with peers who started topiramate.

The GLP-1 users were also about 13% less likely to undergo a nerve block procedure or receive a triptan prescription compared with those taking topiramate.

They were also less likely to be prescribed new preventive migraine medications. Compared with topiramate initiators, GLP-1 initiators were 48% less likely to start valproate, 42% less likely to initiate calcitonin gene-related peptide (CGRP) monoclonal antibodies, 35% less likely to start tricyclic antidepressants, and 23% less likely to begin gepant drugs. There was no significant difference between groups in the initiation of beta-blockers.

The researchers said these preliminary observations point to a potential role for GLP-1 receptor agonists in migraine management and warrant prospective evaluation. 

Plausible Mechanisms 

Reached for comment, Lanfranco Pellesi, MD, PhD, with University of Southern Denmark in Odense, said this study “does not necessarily prove a new role for GLP-1 drugs in migraine, but it adds real-world evidence suggesting they may reduce healthcare use and treatment escalation in people with chronic migraine.”

“A plausible explanation is that GLP-1 receptor agonists have anti-inflammatory and analgesic effects, and they may also improve metabolic factors like obesity and insulin resistance, which are increasingly recognized as linked to migraine burden,” Pellesi, who wasn’t involved in the study, told Medscape Medical News. 

Also providing perspective, Shaheen Lakhan, MD, PhD, neurologist and researcher based in Miami, told Medscape that migraine may be as much a disorder of brain metabolism as it is a disorder of pain. 

“GLP-1 drugs influence systemic inflammation, insulin signaling, and hypothalamic pathways that intersect with the neural circuits involved in migraine. Put simply — if you stabilize the brain’s metabolic environment, you may lower the chance that a migraine attack ignites,” said Lakhan.

He noted that some of the “signal” of benefit of GLP-1s in migraine “may reflect broader improvements in metabolic health rather than a direct anti-migraine effect.”

Lakhan cautioned that while this study provides “an intriguing signal, we should be careful not to over-interpret it. This study doesn’t prove GLP-1 drugs treat migraine, but it does reinforce the idea that treating the body’s metabolic health may influence the brain’s susceptibility to migraine,” he told Medscape. 

The study had no commercial funding. Acar and Lakhan reported no relevant financial relationships. Pellesi has received consultancy fees from Eli Lilly.