It has been so exciting to witness the release of the new CGRP migraine treatments to treat and prevent migraine pain in the recent years. These are the first migraine specific acute medications to come out in decades since the Triptans. They are also the first preventive medications ever developed specifically for migraine!
If you have chronic migraine, CGRP migraine treatment may help prevent migraine attacks and/or make them less severe.
What Is CGRP?
Calcitonin gene-related peptide (CGRP) is a protein that carries pain signals along nerves that are involved in generating the headache pain associated with migraine. CGRP levels increase during a migraine attack. It is truly fascinating that people with chronic migraine may have more CGRP in their blood.  According to Neurology Journal women with chronic migraine had higher levels of CGRP than women with occasional migraine attacks. Even when they were not having a migraine attack, the women with chronic migraine had more CGRP in their blood. According to American Migraine Foundation, if you administer CGRP by an intravenous method to a person with migraine, within four hours, most of them will get a migraine.
How Do CGRP Migraine Treatments Work?
The newly developed CGRP medications block the CGRP protein or its receptor. The medications are administered on different schedules and in different ways. Aimovig and Emgality are given by injection once per month. Ajovy is given by injection every 1 or 3 months. Vyepti is given as a 30-minute infusion once every 3 months. (See the chart below.)
CGRP Treatment and Botox For Migraine
Treating patients who have chronic migraine with both Botox and CGRP antibody injectables could reduce their monthly migraine days by an additional 5.6 days than if they had just received Botox alone. 
Although some doctors have been prescribing both the CGRP migraine treatments in addition to Botox for migraine, at this time, some insurance companies decline to cover this combination. If that’s the case for you, we recommend contacting the CGRP companies directly to inquire about their savings programs.
CGRP Side Effects
The clinical trials on anti-CGRP therapy have reported a limited number of side effects.  The most recent data from the FDA (December 2019) indicates that 4082 of the total reported side-effects (24,573) were related to gastrointestinal disorders (17%). Generally, constipation is a significant anti-CGRP side-effect reported in 3–4% of patients . Here are some tips to relieve constipation if it becomes a problem for you.
At this time, the long-term safety risks of this class of medicines are still unknown. Each patient needs to discuss the medication with their own medical provider and assess whether the benefits outweigh the possible risks just like with any other treatment.
We recommend that you speak to your neurologist or headache specialist about different CGRP migraine treatments currently available and whether they are right for you.
Preventive CGRP Migraine Treatment
Injectable CGRP monoclonal antibodies are administered to prevent migraine. It takes a few months for the CGRP to be reduced, therefore try to be patient if your current treatment is not working.
|Erenumab||Aimovig||70 mg or 140|
|Amgen and Novartis Pharmaceuticals|
every 3 months,
or 1 monthly
|Eli Lilly and Company|
|eptinezumab-jjmr||Vyepti||IV treatment||30- min IV every 3 months||Lundbeck|
Acute Oral CGRP Migraine Treatments
CGRP gepants is a class of acute treatment for migraine taken at the start of an attack. They can be taken as needed in pill form or as a dissolvable tablet at the onset of an attack. At this time, the FDA approved Ubrelvy and Nurtec. Gepants work to block CGRP from attaching to its receptor and initiating pain signals which lead to a migraine attack.
|Acute Medications||Brand Name||Dosage|
|Ubrogepant||Ubrelvy||50-100mg tablet (limit 200mg/day)|
|Rimgepant||Nurtec||75mg orally dissolving tablet (limit 75mg/day)|
|Atogepant (still in development)||n/a||n/a|
Personally, I have used both Aimovig and Emgality, two of the preventive CGRP treatments. Both have helped me control migraine frequency and severity. I did not have any serious side effects with either treatment.
Although my insurance did not cover Aimovig because I was also receiving Botox for migraine, I was able to use the company’s saving’s card. Aimovig’s customer support was extremely helpful and was there for me every step of the way.
Whichever CGRP treatment you choose to try, make sure to contact the company if you are having difficulty with your insurance company.
I also tried Ubrelvy and Nurtec, the two acute CGRP medications. While I did not have not had much success with these two medications, I strongly recommend you try them yourself. Migraine is a spectrum disorder and we all respond to each treatment differently.
I am ecstatic to see the new migraine treatments being produced, approved, and available for the people living with migraine disease. The new line of the CGRP medications offers me so much hope and I hope that it does for you as well.
If you tried any of the new CGRP treatments let us know in the comments or in our closed Facebook group.