CGRP Migraine Drugs and Blood Pressure: What a 6,361-Patient Study Found
A 6,361-patient study found CGRP migraine preventives did not raise blood pressure faster than in similar patients not taking them. Atogepant (Qulipta) users also lost the most weight.
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Why Blood Pressure Comes Up With These Drugs
CGRP is one of the strongest blood vessel relaxers the body makes. Blocking it is how the newer migraine preventives work, and that has always raised a fair question: if you take away a chemical that helps keep blood vessels open, could blood pressure creep up?
The question became more than theoretical in 2021, when the FDA added hypertension to the warnings on the erenumab (Aimovig) label after reviewing reports of people whose blood pressure rose after starting it.2 Since then, studies have pointed in different directions, and most of them looked at erenumab alone.
A new study from the Jefferson Headache Center in Philadelphia, published in Headache on October 25, 2026, compared five CGRP-targeting preventives side by side against similar patients who were not taking any of them, and followed blood pressure and body mass index (BMI) for a year.1
How the Study Worked
This was a retrospective cohort study. The researchers went back through electronic health records from 2018 to 2025 and found adults who had started one of these preventives:
- Erenumab (Aimovig): 1,686 patients
- Galcanezumab (Emgality): 1,178 patients
- Fremanezumab (Ajovy): 930 patients
- Atogepant (Qulipta): 386 patients
- Rimegepant (Nurtec ODT), taken for prevention: 289 patients
They compared these 4,469 people with 1,892 patients who were getting migraine care at the same center but were not on any CGRP-targeting drug. To make the groups as similar as possible, the team used propensity score matching on age, sex, race, starting BMI, starting blood pressure, blood pressure medication use, a history of hypertension, chronic migraine, and how many CGRP drugs a person had tried before.1
Most of the people in the study were women (80.4%), the average age was about 46, and nearly all of them had chronic migraine (between 80% and 97% depending on the group). Average blood pressure at the start was close to 120/76 in every group, and average BMI was about 28.1
The study reported changes as a slope, meaning how much blood pressure or BMI moved per month. To make the numbers easier to picture, we multiplied each monthly figure by 12 to show roughly where things landed after a year. The original monthly values are in the study.
What Happened to Blood Pressure
The comparison group's systolic blood pressure (the top number) drifted up slowly over the year, by about 2 mmHg.1
None of the five drugs pushed blood pressure up faster than that. Three of them were linked to a lower systolic trend than the comparison group:
Systolic blood pressure after 12 months, compared with controls
Dot shows the estimate; the bar shows the 95% confidence interval. Bars that cross the zero line mean no clear difference.
Erenumab was the only drug where blood pressure rose within its own group, by about 1.3 mmHg over the year. That rise was not different from what happened in the comparison group, though, so the study can't pin it on the drug.1
For diastolic pressure (the bottom number), only atogepant showed a difference, about 2 mmHg lower than controls over 12 months. The other drugs tracked the comparison group.1
The researchers also checked whether people who already had hypertension did worse on erenumab. They did not find that: a history of high blood pressure didn't change how blood pressure moved on the drug.1
These are small numbers. A difference of 3 to 5 mmHg across a group can matter for heart and stroke risk at the population level, but it is smaller than the swing most people see between a relaxed reading and one taken in a rushed clinic visit. The study tells us these drugs didn't cause a broad rise in blood pressure. It doesn't prove they lower it.
What Happened to Weight
BMI went up slightly in the comparison group, by roughly a quarter of a point over the year. Two drugs moved in the other direction:1
- Atogepant (Qulipta): about 1.4 BMI points lower than controls after 12 months. For someone who is 5 foot 5, that works out to roughly 8 pounds.
- Erenumab (Aimovig): about 0.4 BMI points lower than controls, a much smaller change.
Fremanezumab, galcanezumab, and rimegepant did not differ from controls on BMI.1
The atogepant finding lines up with an earlier one-year study we covered on atogepant and weight. The authors say the reason is still unclear. Nausea and reduced appetite are known side effects, but they don't seem to explain all of it. CGRP also plays a role in fat tissue and in brain areas that control appetite, and a pill like atogepant may reach those areas in ways the injectable antibodies don't.1
The Results Drug by Drug
| Drug | Patients | Systolic BP vs controls | Diastolic BP vs controls | BMI vs controls |
|---|---|---|---|---|
| Atogepant (Qulipta) | 386 | About 4.6 lower | About 2.2 lower | About 1.4 lower |
| Galcanezumab (Emgality) | 1,178 | About 3.7 lower | No clear difference | No clear difference |
| Fremanezumab (Ajovy) | 930 | About 3.2 lower | No clear difference | No clear difference |
| Rimegepant (Nurtec ODT) | 289 | No clear difference | No clear difference | No clear difference |
| Erenumab (Aimovig) | 1,686 | No clear difference | No clear difference | About 0.4 lower |
Blood pressure in mmHg, BMI in kg/m², estimated over 12 months from the study's monthly slopes. "No clear difference" means the confidence interval crossed zero. Eptinezumab (Vyepti) was not part of this study.
How This Fits With Earlier Research
The evidence on CGRP drugs and blood pressure has been mixed, and nearly all of it has focused on erenumab.
The FDA reviewed 61 reports of raised blood pressure after starting erenumab. Almost half happened within a week of the first dose, and the label was updated to include hypertension as a warning.2
A pooled look at four erenumab trials found hypertension in 0.9% of people on placebo and 0.2% to 0.8% on erenumab, with no added risk.3
A Dutch study of 196 patients on erenumab or fremanezumab found average blood pressure rose by up to about 5 mmHg systolic over a year. Most people stayed in the normal range, but a few needed blood pressure medication.4
At Mayo Clinic, 23.3% of 335 patients on erenumab moved into a higher blood pressure category at follow-up, although average readings barely changed.5
A meta-analysis of erenumab studies found no significant change in average systolic or diastolic pressure, while noting the evidence was fragile.6
A meta-analysis of 19 randomized trials found no increased hypertension risk with CGRP-targeting drugs overall, but rated the certainty as very low because trials enrolled fairly healthy people for short periods.7
The Jefferson study adds something those earlier reports didn't have: a matched comparison group followed over the same year. Without one, it is hard to tell a drug effect from the slow upward drift that happens anyway. That may explain why some uncontrolled studies saw rises and this one didn't.
What This Study Can't Tell Us
The authors list several limits, and they matter for how far these results stretch.1
- Blood pressure came from routine visits. Readings were taken however the clinic happened to take them that day, not under research conditions. Most people had only two or three readings in the year.
- It is observational. Doctors chose who got which drug. Matching helps, but some confounding can remain. For example, a doctor might avoid erenumab in someone whose blood pressure was already creeping up, which could make erenumab look safer than it is.
- The gepant groups were small. With 386 people on atogepant and 289 on rimegepant, the estimates for those drugs are less certain than for the antibodies.
- This was a specialty headache center. Almost everyone had chronic migraine, and few had hypertension at the start (5% to 9%). Results may differ in older people or those with heart disease.
- People who stopped treatment dropped out of the data. If someone quit a drug because their blood pressure went up, that may not be fully captured.
The study was funded by patient donations and the Miles for Migraine charity. Two of the seven authors report consulting or research ties with companies that make migraine drugs, including some of the ones studied.1
What This Means for You
If you are on a CGRP-targeting preventive, or thinking about starting one, this study is reassuring. It found no sign that these drugs as a group raise blood pressure over a year, and it lines up with the 2026 trial meta-analysis.1,7 That said, the erenumab label still carries a hypertension warning, and individual people can respond differently from the average.
- Know your starting blood pressure before you begin a new preventive, and have it rechecked at follow-up visits.
- If you have a home cuff, take a few readings at the same time of day for a week before starting and again a month or two in. Bring them to your next visit; our migraine appointment summary sheet has room for notes like these.
- If you already have high blood pressure, bring it up when choosing a preventive. Some options, like candesartan (Atacand) and propranolol (Inderal), lower blood pressure while preventing migraine attacks.
- Seek care right away for a sudden severe headache that feels different from your usual migraine attacks, chest pain, shortness of breath, or vision changes, especially with a high reading.
- Don't stop a preventive on your own because of one high reading. Talk with your doctor first.
For more on how these drugs compare overall, see our guides to atogepant and rimegepant and to atogepant for prevention, and the AAN and AHS prevention guideline, which covers where each option fits. If you are trying to decide whether your current preventive is doing enough to justify any side effects, the preventive response calculator can help you put numbers to it. Side effects are one of the main reasons people stop these drugs, as our review of how long people stay on anti-CGRP treatment shows.
This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Talk with your healthcare provider before starting, stopping, or changing any migraine or blood pressure medication.
References
- Phan P, Keith S, Li M, Hass R, Hsieh WJ, Marmura M, Yuan H. Longitudinal effects of CGRP-targeting migraine therapies on blood pressure and body mass index: A 12-month retrospective analysis. Headache. 2026. Published online October 25, 2026. doi:10.1111/head.70248
- Saely S, Croteau D, Jawidzik L, Brinker A, Kortepeter C. Hypertension: A new safety risk for patients treated with erenumab. Headache. 2021;61(1):202-208. doi:10.1111/head.14051
- Dodick DW, Tepper SJ, Ailani J, et al. Risk of hypertension in erenumab-treated patients with migraine: Analyses of clinical trial and postmarketing data. Headache. 2021;61(9):1411-1420. doi:10.1111/head.14208
- de Vries Lentsch S, van der Arend BWH, Maassen VanDenBrink A, Terwindt GM. Blood pressure in patients with migraine treated with monoclonal anti-CGRP (receptor) antibodies: A prospective follow-up study. Neurology. 2022;99(17):e1897-e1904. doi:10.1212/WNL.0000000000201008
- Chhabra N, Mead-Harvey C, Dodoo CA, et al. Blood pressure elevation in erenumab-treated patients with migraine: A retrospective real-world experience. Headache. 2024;64(3):233-242. doi:10.1111/head.14679
- Makita LM, de Kleimmann RF, de Oliveira RR, et al. Assessing blood pressure changes and hypertension-related outcomes in patients with migraine treated with erenumab: A systematic review and meta-analysis. Headache. 2025;65(5):871-882. doi:10.1111/head.14921
- Kim K, Kim K, Cho SY, et al. Risk of hypertension after CGRP antagonist treatment in migraine: A systematic review and meta-analysis. Headache. 2026;66(9):2129-2137. doi:10.1111/head.70148
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