Anti-CGRP treatment for migraine

Proven treatment options, designed specifically for migraine

This factsheet was produced by headache doctors and brings together the latest trusted advice and information on anti-CGRP treatment for migraine.

This relatively new class of medication can improve symptoms for most people with migraine, sometimes dramatically. Anti-CGRPs represent an important step forward in the search for more effective treatments.

Unfortunately, anti-CGRP treatment for migraine remains difficult to access through the NHS for many, although by booking an appointment with a headache specialist at the National Migraine Centre, you can get an appointment to discuss treatment options and access to the various medications right away.

What is CGRP?

Calcitonin Gene-Related Peptide (CGRP) is an important chemical involved in transmitting pain signals through the nervous system – and it’s also associated with the triggering of migraine attacks.

It was first discovered in 1984 and has been studied extensively since.

CGRP is a type of protein that is produced by the body and when it builds up in the nervous system, it triggers receptors which open up the pain pathways and start the migraine attack. It is just one of the complex pain chemicals involved in the migraine mechanism.

What are anti-CGRP drugs?

Anti-CGRP injections are designed to stop the action of CGRP.

Anti-CGRP treatment comes in various forms, and it’s important to speak with a headache specialist who can discuss if this form of treatment is right for you and which option you should consider. Headache specialists through the National Migraine Centre can help people from across the UK to access these various treatment types.

You can discuss the various self-injectable treatments, which are usually administered once each month. These are monoclonal antibody medications (mAbs), and include Aimovig, Ajovy and Emgality.

You can also discuss tablet-based gepant treatments that can be used for both episodic and chronic migraine. Clinicians through the National Migraine Centre prescribe Vydura (rimegepant) for the prevention and/or treatment of attacks, and Aquipta (atogepant) for the prevention of attacks.

Finally, the headache specialists may also recommend Vyepti to patients, another mAbs medication, but one which is delivered once every 12 weeks through a drip. The process generally takes around 30 minutes under the supervision of a healthcare professional.

Working with a headache specialist, you can explore the various options and consider which, if any, is appropriate for you. If one treatment fails, or gradually becomes less effective, your headache specialist will be able to discuss the various other anti-CGRP routes in the hope of finding the one that works best for you.

You can find out more about anti-CGRPs and book an appointment here.

Do anti-CGRP medications work for everyone?

Studies vary but anti-CGRPs seem to be effective in at least 50 to 60 per cent of cases for those with chronic migraine, but no single treatment will work for everyone with migraine.

In some cases, the improvement is dramatic and life changing. In others, it is not as effective but can still reduce the severity and frequency of migraine enough to make a real difference to quality of life.

Even if one anti-CGRP medication fails, it is worth discussing with your headache specialist whether others should be considered.

Who are anti-CGRPs suitable for?

They may be useful to anyone with episodic or chronic migraine, with or without aura, with certain exceptions. They are generally well tolerated,.

Anti-CGRPs are unsuitable for the following groups (although note this list does not cover all exclusions – speak with a headache specialist to find out more):

• Those who are pregnant or planning to conceive (the recommendation is to stop them six months before trying to conceive)
• Those aged under 18 years

Some anti-CGRPS may be unsuitable for those with heart disease, so make sure to discuss this with your headache specialist.

How do mAbs work?

MAbs work by targeting the CGRP peptide or its receptors, so blocking the neurochemical pain pathways involved in the migraine mechanism.

These drugs can work in slightly different ways, for instance:

• Aimovig (erenumab) binds itself to the receptor.
• Ajovy (fremanezumab), Emgality (galcanezumab) and Vyepti (eptinezumab) all bind to the protein itself (the ligand).

The most common reported side effects of mAbs are stinging at the site of injection and constipation. Upper respiratory tract infections have been reported by some.

Although generally very well tolerated, you should discuss possible side effects with a headache specialist before proceeding.

If mAbs are going to help, they often start to work more quickly than other preventatives and may improve things even in the first month.

Vyepti tends to work particularly rapidly.

We recommend trying a treatment for three months before judging how effective it is for you.

What if one medication does not work?

If one medication is not working, it’s possible to switch straight over to an alternative anti-CGRP.

If there have been side effects, your headache specialist may recommend a pause before trying an alternative medication.

Is anti-CGRP treatment for migraine available on the NHS?

The situation on NHS access to anti-CGRP treatment for migraine will vary depending on where you are in the UK. Different areas regulate access to medications differently and some medications may not be available everywhere.

Currently, anti-CGRPs are almost always accessed via a specialist headache clinic or consultant neurologist, rather than your GP.

Waiting lists for specialists can be very long indeed, and we hear from patients regularly about the difficulty in getting a referral at all or, when they have managed to do so, excessive waits of many months, sometimes years.

For many medications, you are likely to find that you are unable even to be considered for anti-CGRP treatment for migraine until you can demonstrate that a range of other preventatives (usually at least three) have been tried under the supervision of a clinician, sometimes over the course of many months.

In the case of some medications, you may also have to show that you affected by migraine for more than 15 days each month before you are considered for treatment.

And after all that, some patients still find they are not being considered for prescriptions.

We believe all those who could benefit from anti-CGRPs deserve treatment on the NHS and we support advocacy to improve access for patients.

In the meantime, the National Migraine Centre can provide you with quick and easy access to an expert headache specialist who will be able to discuss with you prescribing anti-CGRP medication right away.

You can find out more about pricing for anti-CGRP medication here or go ahead and request an appointment now.