As many of you know the 2020 Migraine World Summit is going on now. With the current quarantine, I am slowly making my way through videos and will report on what I see as significant in between entertaining my kids 😊. Today, I watched Carl Cincinnato interview Dr Antoinette Maassen van den Brink Professor of Pharmacology at Erasmus University. They discussed the pros and cons of CGRP receptor antagonist drugs. CGRP antagonist migraine drugs are very beneficial for a lot of migraine patients, however long-term side effects do need further study.
The Big Three
Right now, there are three drugs that act on the CGRP in the body: triptans, gepants, and CGRP antagonists. Triptans many of us are fully aware of such as Maxalt, Zomig, Frova, etc. These drugs are acute migraine treatments that do inhibit CGRP somewhat, which may be one reason why they work on migraines for many people. However, if you take too many triptans you can cause medication over use headaches, which I found out the hard way. Once you enter that cycle of medication overuse headaches it’s very difficult and painful to get out of it.
Next are gepants. Gepants are a new class of drug being studied for acute and preventative treatment of migraine. Gepants are antagonist for the CGRP receptor but the molecule is smaller than the already approved CGRP antagonists. One gepant Ubrelvy has just been approved in Dec 2019 by the FDA for acute migraine treatment. It comes in a pill for which many prefer to the injections. Side effects that were often reported were nausea and dizziness. Further study is needed on whether gepants can cause medication overuse.
Finally, there are the CGRP antagonists, Aimovig, Ajovy, and Emgality. These are injectable drugs that block the receptors for CGRP in the body and therefore prevent migraine. The molecules for these antagonists are quite large so they do not cross the blood brain barrier. The half life of these drugs is extremely long, and they stay in your body for long periods of time. However, unlike other migraine preventive treatments such as topomax or Inderal, there are virtually no side effects. The most reported side effect is constipation, which in my experience can be managed with careful water consumption and increased fiber intake.
Pros and Cons
The Pros for the CGRP antagonist are
- Finally, a drug designed specifically for migraine.
- They have less side effects than other preventatives.
- Many experience drastic improvement of quality of life for many chronic migraine patients (myself included).
The Cons for the CGRP antagonists are
- The drugs are very expensive.
- Patients must try other preventative drugs first.
- The long-term safety has not been fully studied.
I have now been on Aimovig for 18 months and I can unequivocally say that it has changed my life. I am currently on a 95-day streak with no headaches, which I haven’t experienced since I was in college 20 years ago. These drugs are a God send to so many migraine patients. I also believe that you can improve their efficacy by making the right diet and lifestyle choices to help your decrease your level inflammation and let the drugs do their work. If you’d like help with your nutrition and lifestyle please contact me today at firstname.lastname@example.org to get a FREE consultation. If you’ve tried any of the CGRP antagonist drugs, please comment below and let me know how they worked for you! I’d love to hear from you.