If you’re keeping up on the latest migraine research, you’re probably seeing this acronym a lot: CGRP. CGRP is the biggest development in migraine treatment in decades and it stands for calcitonin gene-related peptide.
What makes CGRP so important? And how can it help you lessen the toll that migraine is taking on your life? Let us explain.
What’s CGRP?
We get that saying “calcitonin gene-related peptide” doesn’t exactly clear up all of your confusion. That phrase describes a protein that affects the size of the blood vessels in your brain.
Recently, scientists discovered that CGRP levels increase during a migraine attack. Researchers have also found that chronic migraine sufferers (people who experience more than 15 attacks a month) have more CGRP in their blood than people who have attacks less frequently. And that’s true all the time, not just during attacks.
We don’t know why that’s the case (not yet, at least), but it seems clear that higher levels of CGRP are associated with migraine headaches. That’s why pharmaceutical companies are racing to develop anti-CGRP drugs to treat migraine.
What does anti-CGRP treatment do?
Anti-CGRP medications (also called CGRP receptor antagonists or CGRP inhibitors) regulate the levels of CGRP in your brain by either blocking the protein itself or blocking the receptor it attaches to. That means they work to prevent the spike in CGRP that accompanies migraine, which reduces the frequency of attacks, shortens their duration, and alleviates pain and other symptoms.
These medications are a big deal because they’re the first new treatment developed specifically for migraine since triptans came along in the 1990s. Not only that, but they’re the very first preventive option that wasn’t originally intended to treat something other than migraine (unlike, say, anticonvulsants or Botox®).
Is there any evidence that it works?
Yes—the record of research isn’t long, but it’s exciting. In a 2018 study of an anti-CGRP called erenumab (better known as Aimovig®) published in The Lancet, a third of the 121 participants cut their number of monthly headache days by 50% or more after 12 weeks of using the treatment. What makes that even more impressive is that all of the participants had already tried two, three, or four other preventive treatments with no success. Plus, no serious side effects were reported.
Other clinical trials have looked at anti-CGRP treatment’s potential to alleviate symptoms during an attack. In one, 19% of participants who were treated during a migraine attack were pain-free two hours after receiving a dose of rimegepant (a.k.a. Nurtec™ ODT), another anti-CGRP. 37% said the medication completely relieved their other migraine symptoms, like sensitivity to light and sound.
Studies of other anti-CGRPs have shown similar results—the treatments are more effective than placebos at both reducing the frequency of attacks and relieving symptoms during them, often with fewer side effects than many existing medications. Plus, anti-CGRP treatments often become more effective the longer you use them. You can learn more about the science behind anti-CGRP treatment by watching our Q&A with Dr. Charlie Conway, Chief Scientific Officer of the company that developed Nurtec™ ODT.
How do you use anti-CGRP treatment?
That depends on what type of CGRP antagonist you’re using. Many of the treatments that are mainly used for migraine prevention (called “monoclonal antibodies”) are taken by injection, usually once or twice a month. These treatments include:
- Erenumab (brand name: Aimovig®)
- Fremanezumab (brand name: Ajovy®)
- Galcanezumab (brand name: Emgality®)
- Eptinezumab (brand name: Vyepti®)
The one treatment that’s a little bit different in how it’s taken is Vyepti®. It’s administered via a 30-minute IV infusion. Migraine expert and Cove Medical Director Dr. Sara Crystal notes that patients in studies have shown improvement as soon as the day after the infusion.
Are there any oral anti-CGRPs?
The short answer is yes. Most of the monoclonal antibodies listed above have already been approved by the FDA, but pharmaceutical companies are also working on a newer type of anti-CGRP treatment: gepants. These medications work faster than monoclonal antibodies and can be taken by mouth, so they’re better suited to relieve symptoms during migraine attacks. The gepants include:
- Rimegepant (brand name: Nurtec™ ODT)
- Ubrogepant (brand name: Ubrelvy®)
- Atogepant (still in development)
So using an anti-CGRP treatment might mean taking a pill when a headache hits or heading to your doctor’s office every other month and getting a shot. (Some monoclonal antibodies can be self-administered, though, sort of like insulin shots for diabetes.) It all depends on which treatment you choose.
How much does anti-CGRP treatment cost?
Not all of the new anti-CGRP treatments being developed are available yet, but the ones that have hit the market are pretty expensive. For example, Aimovig® currently costs $575 per month (that’s an eyebrow-raising $6,900 per year).
That price gets even more intimidating when you consider the fact that insurance companies are already making it difficult for patients to get these treatments covered. Getting your insurance to cover even just a fraction of the cost of anti-CGRP treatment might mean having to prove that you’ve already tried two or three preventive options without results.
Who should use anti-CGRP treatment?
The CGRP antagonists that are currently available are FDA-approved to treat episodic and chronic migraine, and have been proven effective for migraine with aura or without.
That might make you think they’re great for pretty much any migraine sufferer, but don’t forget about that price tag. Given how costly this treatment is, it’s probably best suited for chronic sufferers who’ve already tried several other options and still can’t find relief.
Who shouldn’t use it?
Scientists don’t know if anti-CGRP treatment is safe to use during pregnancy, so it’s best to steer clear if you’re pregnant or thinking about getting pregnant. Your doctor also might not recommend it if you have a serious illness like diabetes or heart disease.
CGRP helps your body do many things, including keep your blood pressure stable, and it’s not yet known if these migraine treatments might interfere with that.
To sum all that up, CGRP antagonists are a promising new treatment option developed specifically for migraine. They’re effective as an acute or preventive treatment, and can cause fewer side effects than some other medications.
But they’re pricey, and the long-term impact of using them isn’t yet known. If you’re looking for affordable, clinically-proven migraine help, Cove doctors can recommend the right treatment for your needs. Start your consultation today.
The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
Photo by Thought Catalog on Unsplash
