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Migraine Prevention with CGRP Monoclonal Antibodies

Targeted preventive therapy for chronic and refractory migraine

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Nöroloji department. Book Appointment →

What is Migraine Prevention with CGRP Monoclonal Antibodies?

CGRP is a key neuropeptide in migraine pathophysiology, mediating trigeminovascular signaling and neurogenic inflammation.

Four monoclonal antibodies targeting CGRP or its receptor are approved: erenumab (receptor), galcanezumab, fremanezumab and eptinezumab (ligand).

Administered subcutaneously monthly (erenumab, galcanezumab) or monthly/quarterly (fremanezumab), or intravenously quarterly (eptinezumab).

Reduce monthly migraine days by 50 percent or more in approximately 50–60 percent of treated patients in clinical trials.

Favorable safety profile: most common side effects are injection-site reactions, constipation (erenumab), and rare hypertension or cardiovascular events.

Symptoms

Indication: episodic migraine (4–14 monthly migraine days) or chronic migraine (≥15 days/month with ≥8 migraine days)
Inadequate response to or intolerance of two or more conventional preventives (beta-blockers, topiramate, antidepressants)
Patient profile: adult migraine, ability to self-administer (or caregiver-administered), no contraindications
Treatment effects: reduction in monthly migraine days, fewer headache days, reduced acute medication use
Quality of life improvements: reduced disability (MIDAS, HIT-6 scores), better functional capacity, work and family life
Onset of benefit: as early as first month, with maximum effect over 3–6 months

Risk Factors

Active or previous cardiovascular disease, stroke, severe peripheral vascular disease (caution with erenumab in particular)
Pregnancy or planning pregnancy (limited safety data, generally avoid)
Severe Raynaud phenomenon (rare reports of worsening)
Constipation history (worsened by erenumab)
Latex allergy (some autoinjector devices)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Migraine ≥4 days per month interfering with function despite acute treatment
  • Failure of two or more conventional preventives at adequate doses for adequate duration
  • Medication overuse headache complicating chronic migraine
  • Inability to tolerate other preventive options
  • Side effects suggesting cardiovascular concern, severe constipation, or new hypertension

Treatment Methods

01
Headache diary documenting monthly migraine days, severity, acute medication use
02
Detailed history including cardiovascular risk and prior preventive trials
03
Initiate selected anti-CGRP agent based on dosing convenience, comorbidities, route preference
04
Continue acute migraine therapy as needed; consider gepants if triptans contraindicated
05
Reassess response at 3 months; consider continuation if at least 50 percent reduction in migraine days
06
Trial duration of 6–12 months; consider treatment break to assess ongoing need
07
Monitor blood pressure, cardiovascular symptoms; combine with lifestyle measures (sleep, hydration, exercise, trigger avoidance)

Which Department to Visit?

You can visit our Nöroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.