Key TakeawaysCGRP inhibitors have been elevated to a first-line prevention method for migraine, according to the American Headache Society.The first CGRP for migraine prevention was approved in 2018.The medications can be used along previous first-line treatments for migraine.

Key Takeaways

CGRP inhibitors have been elevated to a first-line prevention method for migraine, according to the American Headache Society.The first CGRP for migraine prevention was approved in 2018.The medications can be used along previous first-line treatments for migraine.

In a significant development, the American Headache Society (AHS) has recommended calcitonin gene-related peptide or CGRP-targeting therapies as the initial course of action for preventing migraine attacks, potentially offering a promising avenue for relief,according to a new position statement.

This recommendation comes after reviewing evidence showing the effectiveness, safety, and tolerability of these therapies.By making these treatments first-line options, the AHS hopes to make them more accessible to migraine patients. This guidance is intended to help healthcare providers integrate CGRP-targeting therapies into their practices.

These newer medicines are very effective in preventing and treating migraines,Julia Jones, MD, a neurologist at Houston Methodist Neurological Institute, told Verywell. Thanks to the American Headache Society guidance, she said patients don’t need to wait until other treatments fail to use these therapies.

CGRP Inhibitors for Migraine Treatment

CGRP Inhibitors for Preventing MigrainesmAbsAimovig (erenumab)Ajovy (fremanezumab)Emgality (galcanezumab)Vyepti (eptinezumab)GepantsNurtec (rimegepant)Ubrelvy (ubrogepant)Qulipta (atogepant)

CGRP Inhibitors for Preventing Migraines

mAbsAimovig (erenumab)Ajovy (fremanezumab)Emgality (galcanezumab)Vyepti (eptinezumab)

Aimovig (erenumab)

Ajovy (fremanezumab)

Emgality (galcanezumab)

Vyepti (eptinezumab)

GepantsNurtec (rimegepant)Ubrelvy (ubrogepant)Qulipta (atogepant)

Nurtec (rimegepant)

Ubrelvy (ubrogepant)

Qulipta (atogepant)

During migraines, the brain and nerves, especially the trigeminal nerves, release many inflammatory chemicals and proteins,Leon Barkodar, MD, a neurologist at Neurology Los Angeles, told Verywell.

“We have known for decades that one of these proteins is CGRP,” he said. “Just over the past few years, we finally have medications that can block this inflammatory protein.”

Prior to this new position statement from the AHS, the first-line options for migraine prevention were medications originally intended for other health issues, Jones said. This list includes beta-blockers such as propranolol, anticonvulsants such as (topiramate) and Depakote (divalproex), and antidepressants such as amitriptyline and Effexor (venlafaxine).

“The new CGRP-targeting therapies are used specifically to abort or prevent a migraine,” Jones said.

The updated recommendation does not eliminate the previous approaches entirely; it just elevates CGRP inhibitors to a first-line choice alongside the existing options, offering healthcare providers and patients more flexibility in selecting the most suitable treatment.

“I believe with the newer CGRP-targeting therapies, we have improved overall treatment of patients who have migraines, both acutely and for prophylaxis [prevention],” Jones said, adding these treatments are also suitable to treat medication headaches.

CGRPs can be expensive drugs, with a single dose costing hundreds, sometimes even thousands, of dollars.Aimovig, for example, can cost $6,900 per year.

4 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Burch R, Rizzoli P, Loder E.The prevalence and impact of migraine and severe headache in the United States: figures and trends from government health studies.Headache.2018;58(4):496-505. doi:10.1111/head.13281

Russo AF.CGRP-based migraine therapeutics: how might they work, why so safe, and what next.ACS Pharmacol Transl Sci.2019;2(1):2-8. doi:10.1021/acsptsci.8b00036

American Migraine Foundation.How gepants and ditans complement existing therapies.

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