CGRP Migraine Treatment: Does it Work?

Anybody who suffers from migraine headaches is well aware of the discomfort and debilitating pain that sets in every time they have a migraine attack. Migraine is a type of neurological condition that causes various symptoms. It is known for causing intense and debilitating headaches, along with symptoms like nausea and vomiting, numbness or tingling, difficulty speaking, and sensitivity to sound and light. Migraines tend to run in families and can affect all ages. With the significant advancements in medical research today, there are many new-age treatments that can help a person deal with a migraine in a more effective manner. One such new treatment method is the CGRP migraine treatment, used for preventing and treating migraine pain. Let us take a closer look at this CGRP treatment and if it works or not.

What is CGRP Treatment & How Is It Used To Treat Migraine Pain?

CGRP is a novel treatment technique used to prevent and treat migraine pain.(1) The CGRP migraine medications, also known as CGRP inhibitor, CGRP antagonist treatment, and anti-CGRP, are medicines that block a protein known as calcitonin gene-related peptide (CGRP). (2,3,4,5) CGRP is believed to cause pain and inflammation in the nervous system of people who experience migraine attacks. If you have chronic migraines, you are used to experiencing intense and debilitating headaches along with other symptoms for at least 15 days or more every month, especially if you are seeking treatment for migraines. CGRP migraine treatment is believed to help prevent migraine attacks and also reduces the severity of these attacks.(6)

But how are CGRP medications used to treat migraine pain? People who have chronic migraines have been found to have a higher level of CGRP in their bloodstream. The chemical CGRP has been researched for over 25 years, and it is believed to be the cause of both episodic and chronic migraine.(7)

Research published in the Neurology journal recently found that women who have chronic migraines had significantly higher levels of CGRP in their blood as compared to women who only experienced migraine pain sometimes.(8) The women with chronic migraine were also found to have more CGRP in their blood even when they were not experiencing a migraine attack.

CGRP is, therefore, now believed to have a role in causing migraines. It can also worsen headache pain and make the headache last longer. CGRP migraine treatments work in one of two ways in stopping or treating migraine pain:

CGRP treatments block the sites in and around the brain where the CGRP needs to attach in order to work.

These medications bind to the CGRP and stop it from working.

How is the CGRP Treatment Taken?

There is more than one type of CGRP treatment available in the market today. Some of the main migraine medications that work by targeting CGRP include:

  • Fremanezumab (brand name Ajovy)
  • Erenumab (brand name Aimovig)
  • Galcanezumab (brand name Emgality)(9)
  • Epitinezumab(10)
  • Atogepant

Most CGRP migraine treatments are administered by an injection with a needle or with an automatic pen. This process is similar to how some people with diabetes have to take insulin injections. It is expected that a CGRP medication that can be taken orally by mouth will become available soon.

The dosage of the CGRP drug will depend on your treatment plan, how often you get migraines in a month and the severity of your migraine attack and other associated symptoms. You may need to get the CGRP migraine treatment injection once or twice in a month. There are other CGRP migraine medications that you only need to take once every three months, and you can either administer the injections by yourself at home or go to your doctor’s clinic to have it injected there.(11)

What is the Cost of CGRP Migraine Treatment?

As of February 2021, the cost for one type of CGRP migraine treatment comes to around USD 575 per month or USD 6,900 per year. There are other types of CGRP migraine treatments as well that have different costs. The CGRP migraine drugs are relatively new to the market and, at present, cost more than other types of traditional migraine treatment.

According to the American Migraine Foundation, certain health insurance companies may cover the cost of CGRP migraine treatment if other, more conventional, migraine treatments have not worked for you.(12) To have a better chance with your insurance provider, it is recommended that you document your migraine treatment and also ask your doctor for a letter that states the other therapies were not useful for your condition. In some cases, doctors also call up the insurance provider directly to explain the requirement of a CGRP migraine treatment.

Are There Any Risks Associated With The CGRP Migraine Treatment?

Being a new treatment approach for migraine attacks, all the effects of CGRP treatments are not yet known. There could be various long-term risks that can take place in some people. More research is still being done on these drugs.

Currently, most CGRP migraine treatments need to be injected, which may cause some pain at the site of injection. Furthermore, there is a possibility of the injection site on the skin to become infected. Cleaning the site, washing your hands before administering the injection, and using new, sterilized needles every time are some essential steps you need to follow.

CGRP in the body also has a role to play in the widening or dilating of the blood vessels. This helps in maintaining a balance of your blood pressure. Migraine treatments that work by lowering CGRP levels may have some potential side effects that affect the heart and your blood pressure.(13,14)

Some of the potential risks of CGRP migraine treatment include:

  • High blood pressure or hypertension
  • Constricting or narrowing of some blood vessels
  • Working against other medications that are being taken to lower blood pressure
  • Working against the body’s natural ability to dilate the blood vessels.

We also know that CGRP is involved in carrying out other body functions. For example, it has a role to play in wound healing and also helps with some of the digestive organs. Due to lack of research, it is yet unknown if blocking the CGRP protein can have an impact on wound healing or trigger other digestive issues in a person.(15)

What Are The Benefits Of The CGRP Migraine Treatment?

The CGRP migraine treatments are believed to work best for people who have not got any relief from other conventional migraine treatments. A 2018 study discovered that nearly a third of people using this novel treatment-experienced 50 percent lesser migraines.(16) The study also found that the migraine symptoms in the participants lasted for fewer days. Another study found that a third of the participants with migraines experienced 75% improvement in the frequency and severity of their migraine symptoms.(17)

In any case, certain migraine medications may automatically stop being effective if they are used for a long time. As of now, CGRP migraine treatments have not been found to lose their effect after a certain period of time on treating and preventing migraines.

CGRP migraine treatments are generally only needed once or twice a month for most. This makes it easier for people who have migraines to not miss their medication dose. At the same time, people do not need to wait to experience a migraine attack in order to get treated.

Conclusion

CGRP migraine treatment is a novel treatment, and it is likely to work better for some people with migraines than the other conventional migraine treatments. However, just like any other type of therapy, CGRP migraine medications might not be correct for everyone. This is especially true if you have other underlying chronic diseases like diabetes, high blood pressure, heart disease, or digestive issues. In such cases, your doctor is unlikely to recommend that you opt for CGRP migraine treatment.

These new CGRP migraine treatments provide relief from migraine in three major ways:

  • They help prevent migraine attacks from happening.
  • They reduce the pain and other symptoms of migraines significantly.
  • They also shorten the duration of time a migraine lasts.

You should talk to your doctor to determine if CGRP migraine treatment could be the right fit for you. If you do not have any other chronic illnesses, your doctor may recommend that you try out this treatment for a couple of months.

Before and while taking CGRP medication, it is important that you maintain a daily symptom journal. This will let you and your doctor know of all the changes in migraine symptoms you experience, thus allowing you know if the treatment is working. It will also help you keep track of any side effects of the CGRP migraine treatment.

References:

  1. Kelman, L. and Tanis, D., 2006. The relationship between migraine pain and other associated symptoms. Cephalalgia, 26(5), pp.548-553.
  2. Edvinsson, L., Haanes, K.A., Warfvinge, K. and Krause, D.N., 2018. CGRP as the target of new migraine therapies—successful translation from bench to clinic. Nature Reviews Neurology, 14(6), pp.338-350.
  3. Deen, M., Correnti, E., Kamm, K., Kelderman, T., Papetti, L., Rubio-Beltrán, E., Vigneri, S., Edvinsson, L. and Van Den Brink, A.M., 2017. Blocking CGRP in migraine patients–a review of pros and cons. The journal of headache and pain, 18(1), p.96.
  4. Edvinsson, L., 2019. Role of CGRP in migraine. In Calcitonin Gene-Related Peptide (CGRP) Mechanisms (pp. 121-130). Springer, Cham.
  5. Benemei, S., Nicoletti, P., Capone, J.G. and Geppetti, P., 2009. CGRP receptors in the control of pain and inflammation. Current opinion in pharmacology, 9(1), pp.9-14.
  6. Silberstein, S.D., 1995. Migraine symptoms: Results of a survey of self‐reported migraineurs. Headache: The Journal of Head and Face Pain, 35(7), pp.387-396.
  7. Bigal, M.E., Walter, S. and Rapoport, A.M., 2013. Calcitonin gene‐related peptide (CGRP) and migraine current understanding and state of development. Headache: The Journal of Head and Face Pain, 53(8), pp.1230-1244.
  8. Cernuda-Morollón, E., Larrosa, D., Ramón, C., Vega, J., Martínez-Camblor, P. and Pascual, J., 2013. Interictal increase of CGRP levels in peripheral blood as a biomarker for chronic migraine. Neurology, 81(14), pp.1191-1196.
  9. Stauffer, V.L., Dodick, D.W., Zhang, Q., Carter, J.N., Ailani, J. and Conley, R.R., 2018. Evaluation of galcanezumab for the prevention of episodic migraine: the EVOLVE-1 randomized clinical trial. JAMA neurology, 75(9), pp.1080-1088.
  10. Dodick, D.W., Lipton, R.B., Silberstein, S., Goadsby, P.J., Biondi, D., Hirman, J., Cady, R. and Smith, J., 2019. Eptinezumab for prevention of chronic migraine: A randomized phase 2b clinical trial. Cephalalgia, 39(9), pp.1075-1085.
  11. Mason, B.N., Kaiser, E.A., Kuburas, A., Loomis, M.C.M., Latham, J.A., Garcia-Martinez, L.F. and Russo, A.F., 2017. Induction of migraine-like photophobic behavior in mice by both peripheral and central CGRP mechanisms. Journal of Neuroscience, 37(1), pp.204-216.
  12. Americanmigrainefoundation.org. 2020. [online] Available at: <https://americanmigrainefoundation.org/resource-library/what-to-know-about-the-new-anti-cgrp-migraine-treatment-options/> [Accessed 27 December 2020].
  13. Moehring, F. and Sadler, K.E., 2019. Female-Specific Effects of CGRP Suggest Limited Efficacy of New Migraine Treatments in Males. The Journal of Neuroscience: the Official Journal of the Society for Neuroscience, 39(46), pp.9062-9064.
  14. Rivera-Mancilla, E., Villalón, C.M. and MaassenVanDenBrink, A., 2020. CGRP inhibitors for migraine prophylaxis: a safety review. Expert Opinion on Drug Safety, 19(10), pp.1237-1250.
  15. Haanes, K.A., Edvinsson, L. and Sams, A., 2020. Understanding side-effects of anti-CGRP and anti-CGRP receptor antibodies. The Journal of Headache and Pain, 21(1), pp.1-2.
  16. Reuter, U., Goadsby, P.J., Lanteri-Minet, M., Wen, S., Hours-Zesiger, P., Ferrari, M.D. and Klatt, J., 2018. Efficacy and tolerability of erenumab in patients with episodic migraine in whom two-to-four previous preventive treatments were unsuccessful: a randomised, double-blind, placebo-controlled, phase 3b study. The Lancet, 392(10161), pp.2280-2287.
  17. Practical Pain Management. 2020. CGRP Inhibitors, Aimovig, And Migraine Prevention. [online] Available at: <https://www.practicalpainmanagement.com/pain/headache/new-frontier-migraine-management-inside-cgrp-inhibitors-migraine-prevention> [Accessed 27 December 2020].

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