Ultrasound assessment of cerebrovascular risk via breath-holding index in migraine patients treated with anti-CGRP monoclonal antibodies: a pilot study

Gianvito Barbella; Pietro Antenucci; Vittorio Govoni; Ilaria Casetta; Maurizio Paciaroni; Marina Padroni

doi:10.15557/jou.2026.0016

Ultrasound assessment of cerebrovascular risk via breath-holding index in migraine patients treated with anti-CGRP monoclonal antibodies: a pilot study

Journal of Ultrasonography

Volume 26 (2026): Issue 105 (June 2026)

By: Gianvito Barbella , Pietro Antenucci , Vittorio Govoni , Ilaria Casetta , Maurizio Paciaroni and Marina Padroni

Open Access

|Jun 2026

Abstract

Aim

Migraine is the second most disabling condition worldwide. Monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway represent an effective prophylactic treatment; however, their impact on cerebral hemodynamics remains unclear. The aim of this pilot study was to evaluate cerebrovascular risk in patients with migraine without aura treated with these therapies, by calculating the breath-holding index (BHI) of the anterior cerebral circulation using transcranial color-coded Doppler (TCCD) ultrasonography.

Material and methods

Cerebral vasomotor reactivity to hypercapnia was assessed using the breath-holding test combined with TCCD ultrasonography in 40 patients with migraine without aura undergoing treatment with anti-CGRP monoclonal antibodies and 40 healthy subjects. BHI values and other key cerebrovascular parameters were compared between the groups.

Results

The BHI values in patients with migraine without aura were not below the threshold predictive of increased cerebrovascular risk (less than 0.69% per second, as referenced in the general population). No significant differences were observed in major cerebrovascular parameters between cases and controls. Additionally, a subanalysis revealed no significant differences based on the specific monoclonal antibody (erenumab, fremanezumab, or galcanezumab) or clinical response status (responders versus non-responders).

Conclusions

Our findings suggest that treatment with anti-CGRP monoclonal antibodies is not associated with a BHI indicative of increased cerebrovascular risk. Notably, this is the first study to include galcanezumab and fremanezumab in the evaluation of cerebrovascular risk using ultrasound, highlighting TCCD ultrasonography as a practical and non-invasive tool for the assessment of cerebrovascular reactivity in migraine.

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Articles in this issue

DOI: https://doi.org/10.15557/jou.2026.0016 | Journal eISSN: 2451-070X | Journal ISSN: 2084-8404

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Language: English

Submitted on: Oct 1, 2025

Accepted on: Feb 24, 2026

Published on: Jun 30, 2026

Published by: MEDICAL COMMUNICATIONS Sp. z o.o.

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

migraine,

monoclonal antibodies,

transcranial ultrasound,

anti-CGRP,

vasomotor reactivity

Related subjects:

Medicine,

Basic medical science,

Basic medical science, other

© 2026 Gianvito Barbella, Pietro Antenucci, Vittorio Govoni, Ilaria Casetta, Maurizio Paciaroni, Marina Padroni, published by MEDICAL COMMUNICATIONS Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 26 (2026): Issue 105 (June 2026)