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Migraine-specific preventive medications targeting the CGRP pathway are safe and effective.

Around one billion people worldwide have migraine. Migraine is a neurological disease that causes severe headaches. Many of those with migraine need preventive medications as their attacks cause severe disability or happen several times a month. Almost all common migraine preventive medications were initially used to treat other disorders, and their effect on migraine prevention was discovered only later. They include antidepressants like amitriptyline, blood pressure-lowering drugs like propranolol and candesartan, anticonvulsants like topiramate, and Botox injections.

However, new medicines have recently been developed for migraine prevention. These are designed to prevent migraine attacks by blocking a pathway related to a small molecule named calcitonin gene-related peptide (CGRP). CGRP is suggested to be an essential part of migraine pathophysiology. There are two groups of anti-CGRP medications:

1- CGRP monoclonal antibodies, including the following medications:

Erenumab (Aimovig): is injected subcutaneously every month.

Fremanezumab (Ajovy): is injected subcutaneously every monthor every three months.

Galcanezumab (Emgality): is injected subcutaneously every month.

Eptinezumab (Vyepti): is injected intravenously every three months.

2- Gepants or small molecule CGRP receptor antagonists, including the following:

Atogepant (Qulipta): is administered orally every day.

Rimegepant (Nurtec): is administered orally every other day.

My latest collaborative research shows that both types of anti-CGRP medications prevent migraine by reducing one to two migraine headache days in a month, compared to placebo. The study was conducted by headache researchers from different centres globally and included 19 trials with about 14,500 participants overall. We reviewed and analysed this existing research to show that these medications were safe and seldom resulted in therapy cessation. Constipation and injection site reactions were notable side effects.

Our research helps us better understand the new medications and improve migraine treatment plans in the future.

However, more studies are needed to evaluate their long-term effects, their safety in pregnancy and lactation, and people with other conditions such as cardiovascular disorders.

The result is published in the Cephalalgia journal, the official journal of the International Headache Society, as part of a special issue titled “New Migraine Drugs”, available here.

Efficacy review:

Safety review:

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