CGRP Inhibitors for Migraine

June 27th, 2023
CGRP antagonist

Migraine is a pain.

While several over-the-counter and prescription medications can treat migraine, not all are good at easing symptoms like head pain, nausea, vomiting, and sensitivity to light that can last a few hours or a few days.

For the 36 million Americans who have migraine, treating the symptoms is one part of the battle: Another critical goal is preventing the painful headaches, and there hasn’t been a medication for that. Until now.

In 2018, the FDA approved the first calcitonin gene-related peptide (CGRP) inhibitors. These new drugs are designed to prevent episodic migraine (up to 14 headache days per month), chronic migraine (15 headache days per month or more), and medication overuse headaches. CGRP inhibitors were the first class of drugs developed to prevent migraines with or without visual auras. Experts recommend their use for those with 6 or more migraine days per month, or when older preventive migraine treatments fail or are not tolerated by the migraine sufferer.

In 2021 a subset of CGRP inhibitors were approved to treat acute migraine. The American Migraine Foundation calls CGRP inhibitors, “the biggest news in migraine treatment and prevention in decades.”

CGRP is the acronym for calcitonin gene-related peptide. It’s involved in a lot of body processes: It regulates blood pressure, helps with tissue repair and wound healing, and contributes to inflammation.

When CGRP is released in the brain, it affects the trigeminal nerve, which is responsible for communicating pain and sensitivities to touch and temperature. CGRP also causes inflammation and pain that happens during a migraine; it makes headache pain worse and causes headaches to last longer. It appears that those who are diagnosed with migraine have more CGRP in their blood.

CGRP inhibitors are drugs that block CGRP from binding to CGRP receptors, a key contributor to the trigeminal nerve pain and inflammation of migraine. Some are FDA-approved for preventing migraine, others for treating acute migraine, and one is approved for both acute and preventive therapy.

The two classes of these drugs are monoclonal antibodies and small molecule CGRP antagonists. The CGRP monoclonal antibodies are large molecule drugs that are given as self-injections or IVs. The shots are given with an automatic pen (similar to the injection pens used for insulin) every month or quarterly (four times per year), depending on the drug. The small molecule CGRP antagonists are taken by mouth in pill form.

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At Pain Spa, Dr Krishna is highly experienced in management of patients with chronic migraines. Please contact us for further details if you are interested in having a consultation with Dr Krishna.