Comparative Real-World Outcomes of OnabotulinumtoxinA and CGRP Monoclonal Antibodies in Chronic Migraine

Lin, Chun-Fu; Chung, Chen-Chih; Chen, Jia-Hung; Chi, Nai-Fang; Hu, Chaur-Jong; Huang, Hung-En; Chen, Chih-Chung; Yeh, Tu-Hsueh; Wei, James Cheng-Chung; Lee, Hsun-Hua

doi:10.3390/jcm15134963

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Comparative Real-World Outcomes of OnabotulinumtoxinA and CGRP Monoclonal Antibodies in Chronic Migraine

by

Chun-Fu Lin

^1,2,3

,

Chen-Chih Chung

^3,4

,

Jia-Hung Chen

^3,4,

Nai-Fang Chi

^5,6,

Chaur-Jong Hu

^1,2,3,4

,

Hung-En Huang

^7,8,

Chih-Chung Chen

^2,3,4,

Tu-Hsueh Yeh

^1,2,3

,

James Cheng-Chung Wei

^8,9,10,*,† and

Hsun-Hua Lee

^1,2,3,*,†

¹

Department of Neurology, Taipei Medical University Hospital, Taipei Medical University, Taipei 110301, Taiwan

²

Dizziness and Balance Disorder Center, Taipei Medical University Hospital, Taipei Medical University, New Taipei City 235061, Taiwan

³

Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan

⁴

Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan

⁵

Department of Neurology, Neurological Institute and Stroke Center, Taipei Veterans General Hospital, Taipei 112201, Taiwan

⁶

School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan

⁷

Center for Health Data Science, Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402306, Taiwan

⁸

Institute of Medicine, Chung Shan Medical University, Taichung 402306, Taiwan

⁹

Division of Allergy, Immunology & Rheumatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 402306, Taiwan

¹⁰

Graduate Institute of Integrated Medicine, China Medical University, Taichung 404328, Taiwan

^*

Authors to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

J. Clin. Med. 2026, 15(13), 4963; https://doi.org/10.3390/jcm15134963 (registering DOI)

Submission received: 7 May 2026 / Revised: 16 June 2026 / Accepted: 22 June 2026 / Published: 25 June 2026

(This article belongs to the Special Issue Advances and Updates in Migraine)

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Abstract

Background: OnabotulinumtoxinA and calcitonin gene-related peptide (CGRP) monoclonal antibodies are widely used for chronic migraine prevention, but comparative real-world evidence on healthcare utilization remains limited. This study aimed to compare the association of onabotulinumtoxinA versus CGRP monoclonal antibodies with acute triptan prescription and migraine-related return visits in patients with chronic migraine. Methods: We conducted a retrospective cohort study using the TriNetX global federated electronic health record database from 2018 to 2024. Adults with chronic migraine who initiated onabotulinumtoxinA or a CGRP monoclonal antibody were matched 1:1 by propensity score. The primary outcomes were time to acute triptan prescription and time to first migraine-related return visit during follow-up. Results: After propensity score matching, 10,140 patients were included in each treatment group. OnabotulinumtoxinA was associated with a lower hazard of acute triptan prescription than CGRP monoclonal antibodies (hazard ratio 0.513, 95% confidence interval 0.481–0.546; p < 0.001), whereas migraine-related return visits were similar between groups (hazard ratio 1.008, 95% confidence interval 0.977–1.039; p = 0.69). Conclusions: In this multicenter real-world analysis, onabotulinumtoxinA was associated with a lower hazard of acute triptan prescription than CGRP monoclonal antibodies, while migraine-related return visits were comparable. These findings reflect treatment-related healthcare utilization patterns in routine practice and should be interpreted considering the limitations of retrospective electronic health record data.

Keywords: chronic migraine; onabotulinumtoxinA; CGRP monoclonal antibodies; real-world evidence; propensity score matching

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MDPI and ACS Style

Lin, C.-F.; Chung, C.-C.; Chen, J.-H.; Chi, N.-F.; Hu, C.-J.; Huang, H.-E.; Chen, C.-C.; Yeh, T.-H.; Wei, J.C.-C.; Lee, H.-H. Comparative Real-World Outcomes of OnabotulinumtoxinA and CGRP Monoclonal Antibodies in Chronic Migraine. J. Clin. Med. 2026, 15, 4963. https://doi.org/10.3390/jcm15134963

AMA Style

Lin C-F, Chung C-C, Chen J-H, Chi N-F, Hu C-J, Huang H-E, Chen C-C, Yeh T-H, Wei JC-C, Lee H-H. Comparative Real-World Outcomes of OnabotulinumtoxinA and CGRP Monoclonal Antibodies in Chronic Migraine. Journal of Clinical Medicine. 2026; 15(13):4963. https://doi.org/10.3390/jcm15134963

Chicago/Turabian Style

Lin, Chun-Fu, Chen-Chih Chung, Jia-Hung Chen, Nai-Fang Chi, Chaur-Jong Hu, Hung-En Huang, Chih-Chung Chen, Tu-Hsueh Yeh, James Cheng-Chung Wei, and Hsun-Hua Lee. 2026. "Comparative Real-World Outcomes of OnabotulinumtoxinA and CGRP Monoclonal Antibodies in Chronic Migraine" Journal of Clinical Medicine 15, no. 13: 4963. https://doi.org/10.3390/jcm15134963

APA Style

Lin, C.-F., Chung, C.-C., Chen, J.-H., Chi, N.-F., Hu, C.-J., Huang, H.-E., Chen, C.-C., Yeh, T.-H., Wei, J. C.-C., & Lee, H.-H. (2026). Comparative Real-World Outcomes of OnabotulinumtoxinA and CGRP Monoclonal Antibodies in Chronic Migraine. Journal of Clinical Medicine, 15(13), 4963. https://doi.org/10.3390/jcm15134963

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Comparative Real-World Outcomes of OnabotulinumtoxinA and CGRP Monoclonal Antibodies in Chronic Migraine

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