Calcitonin gene-related peptide (CGRP) monoclonal antibodies, or CGRP antagonists, are one of the newer treatment options for the prevention of migraine.
In recent years, pharmaceutical companies have tested drugs in this class to dramatically reduce the frequency of migraine episodes for people with chronic migraine. Several are FDA approved.
The results of early clinical trials, presented at the American Headache Society’s annual meeting in Washington, D.C., were promising.
“The potential of these new compounds is enormous and gives us real hope that effective specific treatments for migraine may be on the near horizon,” said Dr. Peter J. Goadsby, PhD, the chief of the University of California, San Francisco, Headache Center in 2015. “The development of CGRP antibodies offers the simple, yet elegant and long-awaited option for migraine patients to finally be treated with migraine preventives; it’s a truly landmark development.”
Calcitonin gene-related peptide (CGRP) monoclonal antibodies work by bringing down levels of CGRP, which transmits pain. Monoclonal antibodies are a part of a drug class called biologics.
In 2018, the first CGRP antagonists were FDA approved for migraine treatment. These include:
- erenumab (Aimovig)
- fremanezumab (Ajovy)
- galcanezumab (Emgality)
These medications are taken by injection. The dosage and frequency of injection may vary depending on your symptoms.
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In 2020, CGRP antagonist eptinezumab (Vyepti) was FDA approved for preventive migraine treatment. It is the first intravenous (IV) treatment for preventing migraine. One clinical trial found that eptinezumab could cut monthly migraine days by half after 6 months.
In late 2021, atogepant (Qulipta) became the fifth CGRP antagonist to receive FDA approval for migraine prevention. It is taken orally once a day in the form of a tablet, but the dosage may vary depending on whether you are taking other medications.
If you have chronic migraine, speak with your doctor about whether CGRP antagonists might help you find relief from symptoms.
In addition to CGRP monoclonal antibodies, there are other treatment options for migraine prevention. These include:
- beta-blockers
- antidepressants
- anticonvulsants
- calcium channel blockers
- botulinum toxin type A (Botox)
These drugs work to reduce the severity and frequency of migraine symptoms. In most cases, they may be used in combination with other treatment.
Talk with your doctor about making a preventive treatment plan that is right for you.
According to the American Migraine Foundation, almost 40 million people in the United States have migraine. This number is likely higher because many people are undiagnosed. People with chronic migraine may have more than 15 migraine days a month.
The last breakthrough in migraine treatment was triptans, which were released in 1991. Triptans treat, rather than prevent, migraine attacks. Taking triptans alongside CGRP inhibitors can yield positive effects for people with migraine.
“This development [of CGRP antagonists for migraine prevention] is a transformative moment in migraine treatment,” said Goadsby in 2015. “There’s no question that we need something better. In fact, for prevention we really need something designed specifically for migraine.”
Since 2018, calcitonin gene-related peptide (CGRP) monoclonal antibodies, or CGRP antagonists, have emerged as an effective treatment for the prevention of migraine headaches.
This is a growing class of drugs. The drugs that are FDA approved for migraine prevention include:
- erenumab (Aimovig)
- fremanezumab (Ajovy)
- galcanezumab (Emgality)
- eptinezumab (Vyepti)
- atogepant (Qulipta)
CGRP antagonists work by blocking CGRP, which may cause pain in the nervous systems of people with migraine. Speak with your doctor if you think CGRP antagonists might help treat your migraine symptoms.