If you’ve ever had a migraine, you know how painful and debilitating it can be. In fact, migraine is the No. 1 disabling condition in women under age 50 and the second disabling condition for all adults, according to the Global Burden of Disease study. Some people have chronic migraines, defined as head pain that occurs 15 or more days each month for more than three months.
Specifically, a migraine is a neurological disorder that can cause throbbing on one or both sides of the head. For some people, a migraine also may cause symptoms like nausea and sensitivity to light or sound.
A migraine can have many triggers, including:
— Certain foods and drinks.
— Hormonal changes.
— Stress.
“Headache is pain in the head of any cause. Migraine is a specific disorder that causes headache and other symptoms,” explains Dr. Richard Lipton, professor and vice chair of neurology at Einstein and Montefiore Health System and director of the Montefiore Headache Center in New York City.
[SEE: Headache Locations and Their Meanings.]
Migraine Treatments
There are many treatments for migraines that are available both over the counter and by prescription, including:
— Nonsteroidal anti-inflammatory drugs, like ibuprofen and naproxen.
— Acetaminophen.
— Aspirin.
— Caffeine combined with NSAIDs, acetaminophen or aspirin.
— Ergotamines.
— Opioids.
— Triptans, like almotriptan and sumatriptan.
— CGRP inhibitors.
[SEE: Best Foods to Eat — and Avoid — for Migraines.]
What Are CGRP Inhibitors?
CGRP inhibitors, which stands for calcitonin gene related peptide inhibitors, are a newer type of medicine for migraines. CGRP is a type of protein that can be released in the body and trigger a migraine attack. Research has found that CGRP goes up during migraine attacks, binding to the body’s CGRP receptor and unlocking the pathway leading to migraine pain, Lipton says. A CGRP inhibitor prevents CGRP from unlocking the pathway.
The first CGRP inhibitor approved by the Food and Drug Administration to prevent migraine was erenumab (Aimovig) in 2018. Some CGRP inhibitors have star-studded ads — like Khloe Kardashian and Lady Gaga in ads for rimegepant (Nurtec) and Serena Williams in ads for ubrogepant (Ubrelvy).
There are several CGRP inhibitors available in the U.S. now, including gepants CGRP monoclonal antibodies.
Gepants
Gepants block the CGRP receptor and can be used for acute migraine treatment or preventive migraine treatment. They are available as oral tablets or as a nasal spray.
Examples of gepants include:
— Atogepant.
— Rimegepant (approved for both acute and preventive treatment).
— Ubrogepant.
— Zavegepant.
Gepants can be used at the first sign of a migraine. When used to prevent migraines, it can be taken every other day.
CGRP monoclonal antibodies
The second category of CGRP inhibitors are CGRP monoclonal antibodies. They help to prevent chronic migraines rather than quickly relieving a migraine when you have one. CGRP monoclonal antibodies bind to CGRP itself or the body’s CGRP receptor. Examples include:
— Eptinezumab.
— Erenumab.
— Fremanezumab.
— Galcanezumab.
CGRP monoclonal antibodies, used solely for prevention, are given by injection and may be used monthly or every three months, depending on the specific drug.
[READ: Best OTC Migraine Medication and Relief.]
How Fast Do CGRP Inhibitors Work?
When used to prevent migraines, CGRP therapy should help reduce headache severity and frequency within three months, says Dr. Christina Graley, assistant professor of neurology at Johns Hopkins Medicine in Baltimore.
While some patients may respond to treatment within a month, that’s not guaranteed for everyone.
A 2018 study published in JAMA Neurology of one type of CGRP inhibitor — CGRP monoclonal antibody galcanezumab (Emgality) — found that more than 60% of patients had a 50% decrease or more in their monthly headache days.
“These numbers were previously unheard of in headache prevention,” Graley says.
With gepants, about 60% of patients feel pain relief within two hours, Lipton says. Even if their migraine pain isn’t completely gone, it’s enough to get back to work or to other activities.
Although triptans seem to outperform gepants in scientific reviews, gepants have fewer side effects, says Dr. Teshamae Monteith, a fellow of the American Academy of Neurology and associate professor and chief of the headache division at the University of Miami Health System in Miami.
Who Can Use CGRP Inhibitors?
Most patients who have migraines are good candidates for CGRP inhibitors. Preventive CGRP inhibitors are suitable for those with frequent migraine attacks. Triptans, another commonly prescribed migraine treatment, may cause side effects nausea, dizziness and other side effects. A small percentage of patients may experience heart palpitations. Because triptans narrow blood vessels, your health care provider may recommend avoiding triptans if you have cardiovascular disease or associated risk factors, like high cholesterol and high blood pressure.
Some acute medication for migraine, such as NSAIDS and triptans, can cause a rebound effect, resulting in more frequent migraines. However, this isn’t the case for gepants.
Who Can’t Use CGRP Inhibitors?
You should avoid using CGRP inhibitors or proceed with caution if you:
— Are allergic to gepants.
— Have severe liver or kidney disease. For some people with liver disease, the monoclonal antibody form of CGRP inhibitors may lead to higher blood pressure, says Dr. Susan Broner, a neurologist and medical director of the Headache Program at Weill Cornell Medicine in New York City.
— Are pregnant or breastfeeding. The medication hasn’t been adequately studied for this patient group.
— Are planning to get pregnant. It can take five months for the injectable version to exit the body, which is why you would want to stop it before conceiving, Broner says.
— Use drugs that may interact with gepants, including CYP3A4 inhibitors.
Always discuss other medications that you use with your health care provider.
As CGRP inhibitors are a newer medicine, ongoing research into their safety could reveal other precautions, Graley says.
Side Effects of CGRP Inhibitors
Side effects of CGRP inhibitors can vary depending on the specific drug. They include:
— Injection site reaction for the injectable form.
— Constipation.
— Mild joint pain.
— Nausea.
— Fatigue.
— An unpleasant taste or nasal irritation if using zavegepant, which is taken nasally.
Cost of CGRP Inhibitors
Although CGRP inhibitors for migraine can be effective, they also come with a high price tag. For instance, rimegant (Nurtec) costs more than $1,100 for an eight-pill prescription. That cost is lowered to a little over $900 when using a prescription savings card like GoodRx. Aimovig costs about $900, a price that drops to the $700s or lower $800s with a GoodRx discount.
CGRP inhibitors aren’t currently available through Medicaid or Medicare. However, you may be able to obtain them for a sizable discount or for free through private insurance with the use of a savings card. These savings cards are available on the drug manufacturers’ websites. Many manufacturers also have payment assistance programs that you can apply to.
Other Ways to Prevent and Manage Migraines
If you’re looking for solutions to prevent and manage migraines, there are some other things you can do instead of or in addition to using medications like CGRP inhibitors.
1. Track your migraines with an electronic or paper diary. This can help you look for patterns to find what may trigger them, such as certain foods, stress or menstruation. If you use a smart fitness watch, you may find a calendar on its app where you can mark the days when you had a migraine.
2. Stay hydrated.Being dehydrated can trigger a headache or migraine.
3. Plan on regular physical activity. Physical activity can help lower both how often you get migraines and their intensity. Exercise also releases the body’s natural painkillers. Current federal guidelines recommend 150 minutes of moderate heart-pumping exercise each week.
4. Take your treatment at the first sign of pain. Don’t wait until your head is throbbing and you’re ready to lie down and shut out the world. “The goal of acute treatment is to get rid of the migraine, or at least the most bothersome symptoms, so you can get back to life,” Broner says.
5. See a health care provider for migraines. “Treatment for migraine has never been better,” Lipton says. Many patients who have given up on treatment find that when they seek care again, treatments have improved, he says. Another good time to see a health care provider is if your migraines don’t respond to your current treatment or you have to redose later that day or the next day, Broner adds.
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What Are CGRP Inhibitors for Migraine? originally appeared on usnews.com
Update 02/01/24: This story was published at an earlier date and has been updated with new information.
