Understanding CGRP treatment: how it targets the root cause of migraines

For those who have experienced a migraine, they know all too well how painful and debilitating it can be. A migraine can last a couple of hours to up to a few days, disrupting routine and preventing the person suffering from it from working, engaging with others, or enjoying their lives. However, all hope is not lost, because dedicated neurologist from London, Dr Kushan Karunaratne, explains a cutting-edge treatment option for migraines in this article.

What is a migraine?

Migraines feel like pressure behind the eyes and painful throbbing of the head that worsens as time goes on. They can be triggered due to a variety of reasons — women about to start their periods, people who are fatigued and stressed, or those who are not eating well can often experience them.  There are two types of migraines:

1. Migraines with an aura, which means that there are symptoms that signal that the migraine is about to occur, such as distortion to the vision like orbs or lines, numbness or paresthesia (also known as pins and needles), and dizziness.
2. Migraines without an aura, which means that the onset is sudden and without warning in the form of other symptoms.

In addition to severe pain in the head, migraines can be accompanied by disorientation, poor vision, nausea, loss of appetite, and sensitivity to light and sound. Most of the time, the best a person with a migraine can do is lie down in a dark room and wait. But for those who have chronic migraines, they could be due to a yet undiagnosed, serious internal medical issue, and it is important to consult with a doctor so they may investigate.

What is CGRP therapy, and how can it help against migraines?

For a long time, there wasn’t a specific medicine that one could take to ease or prevent migraines aside from generic painkillers, but thanks to clinical research and dedicated scientists, there have been discoveries that have assisted in the development of migraine treatments. In 1983, the calcitonin gene-related peptide (CGRP), a neurochemical that is produced naturally by the neurons, was discovered, and researchers realised that this substance was part of the reason why the sensation of pain was being felt during a migraine, as it is present in high amounts during migraines.

Thanks to this discovery, there are now specific drugs that target the CGRP and halt it from signalling to the brain and triggering the migraine. The treatment, known as CGRP monoclonal antibodies (mAbs) therapy, is still being developed and tested, but current results from patients are very encouraging, with reports of both the severity and the frequency of migraines reducing.

As of now, four kinds of CGRP mAbs are available in the UK for people who experience chronic migraines:

1. erenumab (Aimovig)
2. fremanezumab (Ajovy) 
3. galcanezumab (Emgality)
4. eptinezumab (Vyepti)

All four medications are administered intravenously, with a dosage period that ranges from every one to three months. There are some known side effects. Aside from pain from the injection site, there have been some reports of constipation and throat infections.

People who are pregnant or planning to be, those with heart diseases, and minors are not suited for CGRP therapy, but there could be developments in the future that avails this treatment to these groups.

If you are interested in trying CGRP treatment for your migraines, Dr Kushan Karunaratne is available for consultation via his Top Doctors profile.