A new and unique class of preventive migraine treatments have been approved by the FDA over the past year which have several benefits over older medications for the prevention of migraine. Anti-CGRP medicines, which are monoclonal antibodies, block the activity of calcitonin gene-related peptide (CGRP) which is a neuropeptide that plays a key role in the occurrence of migraine. When CGRP is released in the brain, it locks onto CGRP receptors and promotes vasodilation and nerve inflammation, which result in migraine pain (Gower, 2018). This novel class of drugs has been shown to significantly reduce the number of headache days in those who have either episodic migraine (defined as less than 15 headache days per month) or chronic migraine (defined as greater than or equal to 15 headache days per month). Moreover, research has demonstrated that in addition to being effective, many patients find anti-CGRP therapies to act faster and have a lower risk of side effects than other types of preventive migraine medicines they have tried (Gower, 2018).
In 2018, three injectable anti-CGRP medications were approved by the FDA. The first medication in this class was approved in May of 2018; erenumab (Aimovig). Erenumab is unique in that it binds to the CGRP receptor to prevent migraine symptoms. The FDA has recently approved two additional CGRP monoclonal antibodies, fremanezumab (Ajovy) and galcanezumab (Emgality), which bind to the CGRP neuropeptide. Unlike other types of drugs that have been used to help prevent migraine symptoms – such as certain antiepileptics, antidepressants and beta-blockers which were originally developed to treat other conditions – anti-CGRP therapies are designed specifically as preventive migraine treatments. Additionally, these anti-CGRP drugs do not cross the blood brain barrier (BBB) and therefore do not have as many side effects (such as dizziness or sedation) compared to older medicines used for preventing migraine. Another benefit of this novel class of drugs is that they have no known drug interactions, do not cause liver toxicity, and are well tolerated; the most common side effect associated with these drugs is injection-site reaction (Gower, 2018).
Randomized placebo-controlled trials have shown that, on average, anti-CGRP medicines reduce the incidence of migraine by about three to four days a month in those with episodic migraine and about six to eight days per month in those with chronic migraine. Additionally, some of the patients in these clinical trials did not need to use their acute medicines as often per month since their symptoms were better managed and they had a lower frequency of migraine (Gower, 2018).
The advent of these new preventive migraine treatments provides patients with another option to help prevent the occurrence of migraine symptoms and therefore improve quality of life. Patients who find these medicines effective will likely have less disruption in their lives from the often-disabling pain of migraine, which can interrupt the ability to function at work, at home, socially, and in other areas of life.
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References:
Gower, T. (2018). Anti-CGRP therapies: A new option for migraine prevention. Health Monitor Medical Update on Migraine Prevention, 8-11.