Anti-CGRP Monoclonal Antibodies: A New Option for Migraine Treatment

What is a migraine?

A migraine is a debilitating type of headache that can last from a few hours to a few days. At the outset of a migraine, overactive nerve cells send impulses to the blood vessels, which triggers the release of certain hormones, such as serotonin, prostaglandins, and estrogen. The release of these hormones causes the blood vessels near the nerve endings to swell, resulting in a migraine. Once an individual has experienced a migraine, they tend to recur.

What is calcitonin gene-related peptide (CGRP)?

Calcitonin gene-related peptide (CGRP) blocking medication is a new treatment option to prevent and treat chronic migraines. Chronic migraines are classified as intense headaches, alongside other migraine symptoms, lasting for 15 or more days per month.

CGRP is an amino acid peptide that is produced in the brain. It attaches to neurons in the brain. These peptides are greater in the bloodstream of individuals experiencing chronic migraines.

CGRP is believed to be the root cause of chronic and episodic migraines. Additionally, CGRP exacerbates pain associated with migraines. CGRP migraine treatment assists in preventing migraines, shortening the length of migraine episodes, and lessening the pain and symptoms associated with migraines.

How do anti-CGRP monoclonal antibodies work?

The anti-CGRP monoclonal antibodies work by blocking the neurons that CGRP attaches to. Monoclonal antibodies adhere to the CGRP receptor on the neuron and prevent the CRGP from attaching to the nerve.

What medications are anti-CGRP monoclonal antibodies?

Various versions of this type of medication are available and include eptinezumab, erenumab, fremanezumab, atogepant and galcanezumab. These medications are taken by injection or a prefilled syringe. Dosage is dependent on the severity and frequency of migraines and is based on individual needs.

Side effects

CGRP inhibitors are typically well-tolerated. Side effects that occur while taking CGRP treatment should be discussed with a medical professional. Potential side effects include, but are not limited to, the following:

• Nausea or vomiting
• Back pain
• Urinary tract infection
• Headache
• Visual problems
• Tingling sensations
• Upper respiratory infection
• Fatigue
• Joint stiffness
• Liver toxicity
• Pain at the injection site
• Dry mouth

Who is a candidate for anti-CGRP monoclonal antibodies?

Anti-CGRP monoclonal antibody treatment may be considered for individuals who have chronic migraines or those who have tried other preventative medications or onabotulinumtoxinA and experienced a lack of response or intolerable side effects. Monoclonal antibodies treatments are normally injected once or twice per month and are considered a preventative type of medication. A health care professional should be consulted to determine if this type of treatment may be beneficial.

Warnings

Anti-CGRP monoclonal antibody treatment is a relatively new treatment option for migraine pain; therefore, long-term risks may not be fully explored. Due to the risk of infection or pain at the injection site, use new needles, properly clean the injection site, and thoroughly sanitize the hands prior to injecting.

This medication can potentially constrict blood vessels, resulting in hypertension. CGRP helps heal wounds and keeps digestive organs healthy; however, the blocking of this peptide could affect the digestive system or cause issues with wound healing. Advanced medical research is being conducted on these drugs.