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CGRP and headache: a brief review

  • Stewart J. TepperEmail author
Review Article
  • 239 Downloads

Abstract

The advent of anti-CGRP medications is an example of translational research made real. Pioneering research by Drs. Lars Edvinsson and Peter Goadsby has yielded the monoclonal antibody therapeutics and will likely also result in the gepants. The availability of MABs represents a watershed moment in the treatment of migraine. These medications have specificity, as they were designed for primary migraine prevention. They work across a group of wide therapeutic targets, episodic migraine, chronic migraine, medication-overuse headache, and episodic cluster headache. They separate from placebo within 1 week, and often show clinical effects within a month or less. They have tolerability similar to placebo. There has been no significant or worrisome safety signal thus far in their use. They manifest unprecedented responder rates at ≥ 75% and even 100%. They lower all acute medication use and can convert patients from chronic migraine to episodic migraine and from acute medication overuse to non-overuse. They work in patients who have already had lack of success with at least 2–4 previous preventive medications. Pent-up demand for designer, well-tolerated, and effective migraine preventive medication in the USA has resulted in more than 100,000 individual patients prescribed erenumab from May to December of 2018, and the numbers continue to increase. The preventive treatment of migraine in the USA has shifted dramatically, and is likely to do so in the rest of the world as well.

Keywords

CGRP Migraine Monoclonal antibodies Gepants Calcitonin gene-related peptide 

Notes

Compliance with ethical standards

Conflict of interest

Grants for research (no personal compensation): Alder, Allergan, Amgen, ATI, Dr. Reddy’s, ElectroCore, eNeura, Neurolief, Scion Neurostim, Teva, Zosano.

Consultant and/or Advisory Boards: Acorda, Alder, Alexsa, Allergan, Alphasights, Amgen, ATI, Axsome Therapeutics, Biohaven, Cefaly, Charleston Labs, DeepBench, Dr. Reddy’s, ElectroCore, Eli Lilly, eNeura, ExpertConnect, GLG, Guidepoint Global, GSK, Impel, Magellan Rx Management, Navigant Consulting, Neurolief, Nordic BioTech, Novartis, Pfizer, Reckner Healthcare, Satsuma, Scion Neurostim, Slingshot Insights, Sorrento, Sudler and Hennessey, Supernus, Teva, Theranica, Trinity Partners, XOC, Zosano.

Stock Options: ATI.

Royalties: Springer.

Salary: Dartmouth-Hitchcock Medical Center, American Headache Society.

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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Neurology DepartmentDartmouth-Hitchcock Medical CenterLebanonUSA
  2. 2.Geisel School of Medicine at DartmouthHanoverUSA

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