CGRP Drugs for Migraine: A New Era in Treatment

Written and verified by Holly Hazen

CGRP drugs for migraine are one of the most exciting breakthroughs in decades. Unlike older medications that were "borrowed" from other conditions, these drugs were designed specifically for migraine prevention and treatment.

For many people who have struggled with limited or ineffective options, CGRP inhibitors represent real hope. While they are not a cure, studies show they can reduce the frequency and impact of migraine attacks, and for some, even transform daily life.

What Are CGRP Drugs for Migraine?

CGRP drugs are just one category within the growing field of migraine medications.

CGRP stands for calcitonin gene-related peptide. This protein is released during migraine attacks and plays a key role in pain transmission. High CGRP levels can make the trigeminal nerve hypersensitive, which triggers hallmark migraine symptoms such as:

• Severe head pain

• Light and sound sensitivity

• Nausea and vomiting
  

The trigeminal nerves are responsible for sensations in the face/head and control actions like chewing and biting.

CGRP inhibitors work by blocking the action of this peptide, reducing migraine activity at its source.

There are two main types:

• Monoclonal antibodies (injections or infusions used for prevention)

• Gepants (oral medications, used for acute attacks or prevention depending on the drug)
  
  

FDA-Approved CGRP Drugs

Here are the current FDA-approved options:

Monoclonal Antibodies (Preventive Treatments)

• Aimovig (erenumab-aooe) - approved May 2018

• Ajovy (fremanezumab) - approved Sept 2018

• Emgality (galcanezumab-gnlm) - approved Sept 2018

• Vyepti (eptinezumab-jjmr) - approved February 2020 (first quarterly IV infusion)
  
  

Gepants (Oral CGRP Receptor Antagonists)

• Ubrelvy (ubrogepant) - approved Dec 2019 (acute treatment)

• Nurtec ODT (rimegepant) - approved Feb 2020 (acute treatment & preventive use)

• Qulipta (atogepant) - approved Sept 2021 (preventive treatment)
  
  

These medications have given patients more flexibility: injections for long-term prevention, or tablets for fast relief and daily prevention options.

How Do CGRP Drugs Work?

During a migraine, CGRP binds to receptors on nerves around the brain and blood vessels, amplifying pain signals.

Monoclonal antibodies "mop up" CGRP or block its receptor before it can trigger migraine pain.

Gepants are small molecules that block the CGRP receptor. Unlike triptans, they don’t cause vasoconstriction, making them a safer option for people with cardiovascular concerns.

What Do the Studies Show?

Clinical trials of CGRP drugs have shown impressive results:

• Many patients report 50% fewer migraine days per month.

• Some experience periods of being completely migraine-free.

• Benefits are often seen within the first 1–2 months of treatment.
  
  

For example:

• Aimovig trials: 40–50% of patients saw migraine days cut in half.

• Vyepti trials: Some reported improvements after just one infusion.
  
  

While results vary, these numbers are promising compared to older preventive options.

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Tip for Migraine Management

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Potential Drawbacks

As with all medications, there are trade-offs:

• Cost: These drugs can be expensive, though many insurance providers now cover them.

• Administration: Some require self-injections or IV infusions.

• Side effects: Generally mild, but can include constipation, injection-site reactions, or nausea.

• Not a cure: They reduce frequency and severity but may not stop attacks completely.
  
  

Still, for people with frequent or disabling migraines, CGRP drugs often make a significant difference.

Making an Educated Decision

If you’re considering CGRP inhibitors:

1. Track your migraine frequency before starting, so you and your doctor can measure progress.
   
   
2. Ask about insurance coverage and co-pay programs.
   
   
3. Discuss which type suits your lifestyle (monthly shot, quarterly infusion, or oral tablet).

Want an easy way to compare all your options?

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FAQs About CGRP Drugs

Final Thoughts

CGRP drugs for migraine mark the first true migraine-specific treatments since triptans in the 1990s. They aren’t perfect, but they’ve changed the game for many people who once felt out of options.

If you’re considering these medications, work closely with your healthcare provider to find the best fit, and remember that combining preventive and acute strategies often works best.

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<sub>CGRP Drugs For Migraine Page Source:
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2. Alder Biopharmaceuticals (2020) Pipeline: eptinezumab. Available [online] at: https://www.alderbio.com/pipeline/eptinezumab/
3. Practice Update (2019) 2019 Top Stories in Primary Care: The Year of the Migraine: Mabs vs Gepants. Available [online] at: https://www.practiceupdate.com/content/2019-top-stories-in-primary-care-the-year-of-the-migraine-mabs-vs-gepants/93766
4. Goadsby PJ, Dodick DW, Trugman JM, et al. Orally administered atogepant was efficacious, safe, and tolerable for the prevention of migraine: results from a phase 2b/3 study (S17.001). Neurology. 2019;92 (15 Suppl):S17.001.
5. Lipton RB, Croop R, Stock EG, et al. Rimegepant, an oral calcitonin gene–related peptide receptor antagonist, for migraine. N Engl J Med. 2019; 381(2):142-149.
6. Lipton RB, Dodick DW, Ailani J, et al. Effect of ubrogepant vs placebo on pain and the most bothersome associated symptom in the acute treatment of migraine: The ACHIEVE II randomized clinical trial. JAMA. 2019; 322(19):1887-1898.
7. Dodick DW, Lipton RB, Ailani J, et al. Ubrogepant for the treatment of migraine. N Engl J Med. 2019;381(23):2230-2241.
8. Migraine Again (2020) VYEPTI for Migraine Prevention Approved by FDA. Available [online] at: https://migraineagain.com/new-vyepti-for-migraine-prevention-approved-by-fda/  Accessed Feb. 20, 2020</sub>