Menu

CGRP Inhibitors for Migraine

Medically Reviewed by Christopher Melinosky, MD on February 14, 2022

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 just part of the battle: The real 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 (fewer than 15 headache days per month), chronic migraine (more than 15 headache days per month), and medication overuse headaches; another drug was approved in 2021. CGRP inhibitors were the first class of drugs developed to prevent migraines with or without visual auras.

The American Migraine Foundation calls CGRP inhibitors, “the biggest news in migraine treatment and prevention in decades.”

What Is CGRP?

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.

What Are CGRP Inhibitors?

CGRP inhibitors block the release of calcitonin gene-related peptides. If there is no CGRP circulating, there is no migraine. Although researchers devoted decades to understanding the role CGRP played in migraine, CGRP inhibitors are a new treatment option.

There are two classes of drugs that block the release of CGRP: small molecule CGRP receptor antagonists and monoclonal antibodies. CGRP migraine medications can also be called anti-CGRP, CGRP inhibitors, CGRP antagonist treatments, and monoclonal antibodies for migraine.

There are five CGRP inhibitors:

Some CGRP inhibitors either block the sites around the brain where CGRP attaches or bind to CGRP and prevent it from causing pain. These medications are either taken as pills or 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.

Studies show that CGRP inhibitors helped make migraines come less often, lessened headache days, and cut medication usage among those who had episodic and chronic migraine with or without aura.

You’ll need a prescription from your doctor for CGRP inhibitors.

What Are the Benefits?

CGRP inhibitors have been shown to work better than conventional migraine medications, which research shows might not be good at relieving migraine pain and often come with side effects, including medication overuse headaches. CGRP inhibitors also appear to work faster than other migraine treatments.

It often takes up to 3 months to figure out whether traditional migraine medications are working, but most people who take CGRP inhibitors to prevent or treat migraine see results in the first month.

What Are the Side Effects?

CGRP inhibitors tend to be well-tolerated. In fact, one study found that those with episodic migraine had no more reaction to the CGRP inhibitor than a placebo (sugar pill), and just 6% of those who gave themselves injections had reactions where they got the shot.

Some mild to moderate side effects from CGRP inhibitors have been reported, including:

  • Nausea
  • Vomiting
  • Back pain
  • Headache
  • Visual problems
  • Tingling or “pins and needles” sensations
  • Dry mouth
  • Upper respiratory infections
  • Urinary tract infections
  • Fatigue
  • Joint stiffness
  • Liver toxicity
  • Pain where you get the shot (for CGRP inhibitors given via injection or IV)

Who Should Take CGRP Inhibitors?

CGRP inhibitors work on episodic and chronic migraines.

Data shows the drugs have a strong safety profile. In fact, the latest research found there were no adverse reactions, even among women who took the medications while pregnant. But researchers noted that the drugs are new and there still isn’t a lot of long-term data, so it’s important to talk to your doctor.

At first, there were some concerns about prescribing CGRP inhibitors to those with heart disease. CGRP is called a vasodilator because it helps the blood vessels dilate, which is important for good heart health; the peptide has also been shown to protect against heart failure and high blood pressure. The results from several clinical trials showed there doesn’t appear to be an increased risk.

For those with episodic migraine, data shows that almost 88% of people studied had fewer headache days. The same study found that CGRP inhibitors significantly reduced the number of headache days for 84% of those with chronic migraine.

Other research has shown that CGRP inhibitors are better at relieving migraine pain than conventional migraine medications. In one study where more than half of participants had previously tried at least two preventive migraine medications, 30% reported that CGRP inhibitors significantly reduced how often they had migraines.

CGRP inhibitors may be especially effective if you have a lot of side effects or don’t get headache relief from conventional migraine medications. Talk to your doctor about whether CGRP inhibitors might be the right medication to treat or prevent migraine.

Show Sources

SOURCES:

American Migraine Foundation.

FDA: “FDA approves novel preventive treatment for migraine.”

Innovations in Clinical Neuroscience: “CGRP Inhibitors for Migraine.”

American Headache Society.

The Journal of Headache and Pain: “Blocking CGRP in migraine patients -- a review of pros and cons.”

Peptides: “Anti-CGRP and anti-CGRP receptor monoclonal antibodies as antimigraine agents. Potential differences in safety profile postulated on a pathophysiological basis.”

Frontiers in Physiology: “The Role of Calcitonin Gene Related Peptide (CGRP) in Neurogenic Vasodilation and Its Cardioprotective Effects.”

Migraine Australia.

The Journal of Headache and Face Pain: “Calcitonin Gene-Related Peptide (CGRP) and Migraine Current Understanding and State of Development.”

The Lancet: “Efficacy and tolerability of erenumab in patients with episodic migraine in whom two-to-four previous preventive treatments were unsuccessful: a randomised, double-blind, placebo-controlled, phase 3b study.”

International Journal of Neurology and Neuropathy: “Migraines and CGRP Monoclonal Antibodies: A Review of Cardiovascular Side Effects and Safety Profile.”

© 2022 WebMD, LLC. All rights reserved. View privacy policy and trust info