CGRP Preventive Drugs for Migraine 2023
Migraine is a genetic/familial related neurologic illness which starts in the second decade of life and usually tapers off after 50-60 years of age. 25% of women and 6% of men have migraine. Migraine is found in 12% of persons in the United States and is the fifth most frequent cause of disability. Migraine is associated with missed school and work. It is a frequent cause of a visit to the emergency room.
Considering the old days of using previous preventive drugs for Migraine like Depakote, Amitriptyline, Topamax, and Propranolol, there is great need for more effective therapy.
This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, the American Headache Society, migraine textbook author, podcaster, YouTuber, and blogger.
The CGRP antibodies have had an impressive impact on Migraine Prevention. All of the drugs work about the same and they provide significant Migraine prevention. The CGRP antibodies interact with other drugs well and have few side effects.
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The big news in migraine treatment now is the advent of the 4 new drugs which interface with CGRP to provide migraine prevention. These four drugs are:
Aimovig
Ajovy
Emgality
Vyepti
All the new drugs except Vyepti are administered subcutaneously in the thigh or abdomen while Vyepti is given intravenously. The drugs are given every 1 to 3 months.
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What is the Migraine Timing Cycle?
In the Migraine Timing Cycle step 1 is trigeminal nerve activation. Then in 20-40 minutes the ganglion of the trigeminal nerve and the artery start to release the neuroinflammatory chemicals: CGRP, Neurokinin A, and Substance P.
These neurochemicals inflame the nerve, the artery, and the human pain center (the thalamus) and start arterial vasodilatation.
The CGRP antibody blocks the release of CGRP, one of the central neurochemicals involved during an attack of migraine.
The MIgraine Timing Cycle
Comments about CGRP:
1. CGRP is released after nerve activation.
2. Perivascular release of CGRP contributes to neurogenic inflammation by inducing vasodilation and dural mast cell degranulation.
3. CGRP is involved in transmission of pain.
4. CGRP levels have been found to be elevated during migraine attacks.
5. Infusion of CGRP can induce migraine attacks in those susceptible to migraine headaches
Report on CGRP antibodies.
The 18th Congress of the International Headache Society reported in 2017 that CGRP Monoclonals: were safe and effective for Migraine Treatment.
All of the CGRP Monoclonals inhibit signaling by calcitonin gene-related peptide (CGRP). In general, they all performed similarly, both in efficacy, safety, and tolerability.
The main differences between the drugs were in doses, routes of administration, and the target of the antibodies.
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All the best.
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Britt Talley Daniel MD
