These Drugs Are the New First Line of Defense Against Migraine

Syeda Khaula Saad
·3 min read
<p>Illustration by Julie Bang for Verywell Health</p>

Illustration by Julie Bang for Verywell Health

Fact checked by Nick Blackmer

Key Takeaways

  • CGRP inhibitors have been elevated to a first-line prevention method for migraine, according to the American Headache Society.

  • The first CGRP for migraine prevention was approved in 2018.

  • The medications can be used along previous first-line treatments for migraine.



In a significant development, the American Headache Society (AHS) has recommended calcitonin gene-related peptide or CGRP-targeting therapies as the initial course of action for preventing migraine attacks, potentially offering a promising avenue for relief, according to a new position statement.

This recommendation comes after reviewing evidence showing the effectiveness, safety, and tolerability of these therapies. By making these treatments first-line options, the AHS hopes to make them more accessible to migraine patients. This guidance is intended to help healthcare providers integrate CGRP-targeting therapies into their practices.

These newer medicines are very effective in preventing and treating migraines, Julia Jones, MD, a neurologist at Houston Methodist Neurological Institute, told Verywell. Thanks to the American Headache Society guidance, she said patients don’t need to wait until other treatments fail to use these therapies.

Related: CGRP Inhibitors for Preventing Migraines

CGRP inhibitors are medications designed to address migraine by inhibiting the function of CGRP, a neuropeptide involved in triggering migraine attacks. There are two types of these drugs: monoclonal antibodies (mAbs) and small-molecule antagonists (gepants). MAbs are injectable medications used for long-term migraine prevention and management, while gepants are oral medications taken to stop acute migraines as needed or for long-term migraine prevention.

Currently, there are four CGRP-targeted mAbs and two gepants approved by the Food and Drug Administration (FDA) for the preventive treatment of migraine. These medications work by stopping CGRP’s action, whether by blocking the receptor site or binding to the CGRP protein itself. This potentially reduces the frequency and severity of migraine attacks.

mAbs

  • Aimovig (erenumab)

  • Ajovy (fremanezumab)

  • Emgality (galcanezumab)

  • Vyepti (eptinezumab)

Gepants

  • Nurtec (rimegepant)

  • Ubrelvy (ubrogepant)

  • Qulipta (atogepant)

During migraines, the brain and nerves, especially the trigeminal nerves, release many inflammatory chemicals and proteins, Leon Barkodar, MD, a neurologist at Neurology Los Angeles, told Verywell.

“We have known for decades that one of these proteins is CGRP,” he said. “Just over the past few years, we finally have medications that can block this inflammatory protein.”

Prior to this new position statement from the AHS, the first-line options for migraine prevention were medications originally intended for other health issues, Jones said. This list includes beta-blockers such as propranolol, anticonvulsants such as (topiramate) and Depakote (divalproex), and antidepressants such as amitriptyline and Effexor (venlafaxine).

“The new CGRP-targeting therapies are used specifically to abort or prevent a migraine,” Jones said.

The updated recommendation does not eliminate the previous approaches entirely; it just elevates CGRP inhibitors to a first-line choice alongside the existing options, offering healthcare providers and patients more flexibility in selecting the most suitable treatment.

“I believe with the newer CGRP-targeting therapies, we have improved overall treatment of patients who have migraines, both acutely and for prophylaxis [prevention],” Jones said, adding these treatments are also suitable to treat medication headaches.

CGRPs can be expensive drugs, with a single dose costing hundreds, sometimes even thousands, of dollars. Aimovig, for example, can cost $6,900 per year.

Insurance coverage for CGRP inhibitors varies depending on the specific plan and may require prior authorization or trying other medications first (like NSAIDs or triptans). The new recommendation by the American Headache Society might influence some insurance companies to become more lenient in covering CGRPs, but this depends on individual plans and negotiations.

Read the original article on Verywell Health.