CGRP Medications: Coming of Age?

For the last few years, we've been talking a lot about CGRP related medications for migraine - that is, CGRP inhibitors and CGRP receptor antagonists. CGRP - calcitonin gene-related peptide neurotransmitters, are involved in pain signals in the body. And so medications have been developed to focus on CGRP in order to prevent migraine or even stop an attack in its tracks.

The recent news is that the American Headache Society (AHS) updated its position statement on CGRP related drugs this month. And that's good news for many who are benefitting or may benefit from this class of medication.

The News

Here's the basic story from the AHS through the PRNewswire:

The American Headache Society (AHS) published a consensus position statement today in Headache: The Journal of Head and Face Pain about the first-line role CGRP-targeting therapies should play in the prevention of migraine. Specifically, the AHS calls for CGRP-targeting therapies to be considered as a first-line approach for migraine prevention, along with previous first-line treatments, without a requirement for prior failure of other classes of migraine preventive treatment.

So what's happening here? Basically, the AHS is acknowleging the generally positive clinical trials and doctor/patient experiences with these drugs. They feel that the time has come to recommend these therapies as a possible first-thing-to-try medication for migraine.

The specific medications included in this report were:

erenumab (Aimovig)
fremanezumab (Ajovy)
galcanezumab (Emgality)
eptinezumab (Vyepti)
rimegepant (Nurtec ODT)
atogepant (Qulipta)

The Good News

There are a number of reasons why this is good news:

It confirms that these medications so far have had a good safety record, a good success record, and that side effects/adverse reactions have been minimal.
Also important is that these drugs seem to have a good cost/benefit ratio. In other words, they're worth the money, both for individual patients and for the health system in general.
That being the case, doctors are now encouraged to recommend these drugs early on, instead of waiting until several other therapies have been tried, which means some patients will get better help sooner.
These types of statements are a move in the right direction for insurance companies. As time goes by and medications are shown to be helpful to patients in the long run, insurance companies are more likely to help with costs.

Cautions and Suggestions

One reason why there are so many studies on CGRP targetting medications is because a lot of money is involved. The AHS itself often gets support from drug companies involved in CGRP medication development.

Yes, this is a caution, but it's not all bad. The fact is, proper studies require attention and funding. A vitamin supplement or a certain vegetable may have amazing health benefits, but without big money involved, it's hard to get the scientific evidence.

CGRP medications are not the cure-all for migraine, and are not for everyone. And yes, we've known for a while that some people experience side effects. But so far the evidence seems to show that they are a major player in the fight against migraine.

This new recommendation from the AHS is another reason to investigate these drugs for yourself, and talk to your doctor. And remember, if one has not worked for you, another one may work better.

For detailed information, check out the full report from the AHS: Calcitonin gene-related peptide-targeting therapies are a first-line option for the prevention of migraine: An American Headache Society position statement update

A couple of briefer summaries here. I especially recommend you take the time to watch the video from the Headache Journal:
American Headache Society Publishes Updated Guidance on Migraine Preventive Therapy
Video: CGRP-targeting tx are a 1st line option for migraine prevention: An AHS position statement update

Migraine World Summit Reminder

Just a reminder - if you were unable to watch all of the Migraine World Summit, the full library is now available for purchase.

This is much more than just the expert interviews (extended versions!). The library includes audio and transcripts (easier on the eyes!), a private support group, and in the case of the VIP Access, updated treatment recommendations and new treatment information.

Yes, the library includes important updated information about CGRP medications, as well as topics such as:

Controlling Chronic Migraine
Balancing Risks & Benefits of Migraine Treatments
Supplements & Foods That Ease Migraine
Menopause, Perimenopause & Migraine
Migraine, TMD & Neck Pain
And much more - see the full list here.

Say what?! Monoclonal Antibodies

Any look at CGRP medications is bound to bring up the topic of monoclonal antibodies (mAbs). In the case of the AHS report, we're talking about the medications erenumab, fremanezumab, galcanezumab, and eptinezumab.

Most people recognize the term "antibody". These are proteins used by your immune system that work like mini-police to "arrest" dangerous actors in your body.

Monoclonal antibodies are created in the lab, and they are special forces designed to seek out specific foreign objects in the body. This is why they can focus on CGRP or the CGRP receptor (as in the case of erenumab).

Thanks for reading! Remember, if you have feedback or ideas for future issues, visit the HeadWay MailRoom. Your password is nomoache.

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