The Migraine Clinic

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CGRP Monoclonal Antibodies

CGRP- monoclonal antibody treatment
These are targeted treatments specifically developed to treat Migraine.

Calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) are a new class of preventive therapies for migraine. They are designed to block CGRP, a neuropeptide associated with the migraine process. Some CGRP mAbs are administered via a subcutaneous injection either monthly or quarterly, while one of these (eptinezumab), is delivered intravenously (a drip directly into the vein), once every three months.

CGRP mAbs work by binding to the CGRP molecule or its receptor, to block and disrupt pain signalling pathways involved in migraine attacks. The use of CGRP mAbs has been associated with significant reductions in both the frequency and severity of migraine episodes.
Gepants, which are CGRP receptor antagonists, represent an additional preventive option. Notably, gepants are the first agents in this class available in tablet form rather than injection or infusion.

Acute Medicines for Migraine

Acute migraine medications relieve headache, nausea, and sensitivity to light or sound, working best when taken at the first sign of pain, particularly in migraines with aura. The choice depends on symptom severity, health conditions, preferences, and available treatments.
  • Anti-sickness medicines like metoclopramide and prochlorperazine manage migraine nausea and aid painkiller absorption. They are best used at migraine onset.
  • Simple Painkillers (Analgesics) include Ibuprofen, aspirin, paracetamol, and naproxen to help ease migraine pain and symptoms.
  • Newer acute migraine drugs such as triptans and gepants are also available.
Preventive Treatments
Preventive medications are considered if:

Preventive migraine medications aim to reduce the frequency and severity of attacks, unlike acute treatments, which treats symptoms during an episode. While acute medications may still be needed for breakthrough symptoms, their use and required dose often decrease with effective prevention. Many preventive options were originally developed for other conditions, including tablets and Botox injections.

Migraine attacks happen frequently, for example, four or more days each month

Migraine episodes interfere with daily activities due to severity or duration

Acute medications do not provide relief, even at maximum tolerated doses

Acute medications are taken regularly on more than two days per week, which can increase the likelihood of medication overuse headache