Headache

American Headache Society: Consider CGRP drugs first line for migraine prevention

March 15, 2024

The American Headache Society (AHS) has issued a consensus position statement urging clinicians to consider CGRP-targeting therapies as a first-line approach for migraine prevention, along with previous first-line treatments, without requiring prior failure of other classes of migraine preventive treatment.

The expert group says that the data indicate that the efficacy and tolerability of CGRP-targeting therapies are equal to or greater than those of previous first-line therapies.

Until recently, headache preventives were drugs created for other diseases (e.g., epilepsy, depression, hypertension) and found to have an effect on migraine. Adherence to these therapies is often poor due to issues with efficacy and tolerability. In contrast, treatments targeting CGRP were engineered based on current scientific understanding of migraine pathophysiology and are the first drugs to be designed specifically for the prevention of migraine and other headache types.

AHS says multiple new migraine-specific therapies have been developed based on a broad foundation of pre-clinical and clinical evidence showing that CGRP plays a key role in the pathogenesis of migraine.

• Researchers collected evidence regarding migraine preventive therapies including primary and secondary endpoints from randomized, placebo-controlled clinical trials, post hoc analyses and open-label extension of these trials, and prospective and retrospective observational studies.
• They say that the evidence for the efficacy, tolerability, and safety of CGRP-targeting migraine preventive therapies (the monoclonal antibodies: erenumab, fremanezumab, galcanezumab, and eptinezumab, and the gepants: rimegepant and atogepant) is substantial, and vastly exceeds that for any other preventive treatment approach.
• Moreover, the evidence remains consistent across different individual CGRP-targeting treatments and is corroborated by extensive "real-world" clinical experience.
• Serious adverse events associated with CGRP-targeting therapies are rare.

Source:

Charles AC, et al. (2024, March 11). Headache. Calcitonin gene-related peptide-targeting therapies are a first-line option for the prevention of migraine: An American Headache Society position statement update. https://pubmed.ncbi.nlm.nih.gov/38466028/