Med. praxi. 2026;23(2):122-127 | DOI: 10.36290/med.2026.002

Biological therapy for migraine

MUDr. Petr Polidar

Neurologická klinika Fakultní nemocnice Olomouc

Migraine is a highly prevalent neurological disorder with substantial impact on quality of life and significant economic consequences. Its pathophysiology involves dysfunction of brainstem structures and activation of neurobiological processes responsible for the clinical manifestation of the disease. Key neuromediators - particularly CGRP - represent major therapeutic targets and form the basis of biological treatment strategies. Conventional therapy is divided into two main approaches: acute and preventive treatment. However, its effectiveness and tolerability are often limited. The central portion of the article focuses on biological therapy - monoclonal antibodies and gepants - which demonstrate high efficacy and a favorable safety profile. Real-world data report ≥ 50 % responder rates of up to 80 % in patients with episodic migraine and 65 % in those with chronic migraine, with slight differences in efficacy and adverse effect profiles between ligand - and receptor-targeting agents. The final section outlines the system of treatment availability in the Czech Republic, reimbursement criteria, and the role of specialized headache centers, including the existence of the ReMIG registry. Biological therapy represents a major advancement in migraine prevention and provides substantial clinical benefit for patients insufficiently responsive to conventional treatment.

Keywords: migraine, CGRP, biologic therapy, small molecules.

Received: December 2, 2025; Revised: January 6, 2026; Accepted: January 8, 2026; Published: April 28, 2026  Show citation