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A New Emerging Treatment for Migraines

Over the past two years have been the most exciting in the world of migraines. New treatments under a group called calcitonin gene-related peptide (CGRP) therapies are emerging as a precision medication that is more targeted. David Dodick, Director of the Headache Program at the Mayo Clinic, stated “in the past two years, seven new drugs with three new targets were created… which is unprecedented in the history of migraine treatment” (Migraine Summit 2021).

What are CGRP antagonist therapies?

For many years, the calcitonin gene-related peptide was believed to influence the pathophysiological processes such as dilation of blood vessels in the brain, release of inflammatory helpers, and carries pain signals from blood vessels causing headache pain.

CGRP receptor blocked preventing pain signals from travelling

The CGRP antagonist therapy acts to blog the attachment of the calcitonin gene-related peptide (yellow) to the receptor (blue), thereby, stopping those pain signals from occurring. An example of this would be the oral medication, rimegepant.

In addition, anti-CGRP monoclonal antibodies, are another therapy that was created to weaken the migraine signalling pathway. They can be used to treat episodic and chronic migraines. An example of this would be eptinezumab.

How are these different from current migraine treatments?

Current management focuses on the acute and preventative management of migraine symptoms. The current practice “gold standard” medications are serotonin receptor agonists, a.k.a., triptans can treat acute migraine episodes. Triptans act on blood vessels to constrict them, decreasing pain signals that might activate pain, and can help limit further release of CGRP.

Triptans may not be prescribed for anyone. Since it may cause vasoconstriction, it may cause complications in individuals with coronary artery disease, a history of stroke, or uncontrolled blood pressure.

CGRP therapies don’t affect the constriction of blood vessels and may be a better option for some.

Are CGRP therapies better than Triptans?

CGRP therapies are a newer generation of medication that can help with migraine sufferers who may not have found a solution to their symptoms. These therapies can work well regardless of how long someone may be experiencing the disease: 5 years vs. 50 years.

Most exciting, a key attribute of CGRP therapy is it may be the first acute treatment for migraine that doesn’t cause medication overuse headache or rebound headaches and can actually improve symptoms for those experiencing medication overuse headaches. Therefore, this is a potential solution for those overusing their acute medications that may not be working that well for them. Also, being on a CGRP therapy may actually drive down the frequency of a headache unlike other medication that may increase the frequency. CGRP therapies can be used to treat both acute migraines and prevent migraines.

Is this available in Canada?

Yes, it seems both CGRP antagonists (rimegepant) and a variety of CGRP monoclonal antibodies therapy are available in Canada. If you are interested in these medications, speak to your family physician about prescribing these medications for your headaches. If you would like to work on getting back to life with your migraines. Book an appointment today with one of our team members to talk more about migraine and headache management, exercise, lifestyle changes, sleep and stress management.

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References:

  1. The American Migraine Foundation (2020). How Gepants and Ditans Complement Existing Therapies. https://americanmigrainefoundation.org/resource-library/gepants-ditans-therapies/
  2. Durham, P. (2006). Calcitonin Gene-Related Peptide (CGRP) and Migraine. The American Headache Society. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134175/pdf/nihms307460.pdf
  3. Stewart, J. (2020). What are the new drugs for the treatment and prevention of migraine? Drugs.com. https://www.drugs.com/medical-answers/new-drugs-treatment-prevention-migraine-3515053/
  4. Dodick, David. Discovering New Treatments Worth Trying. Migraine Summit 2021.

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