How Are CGRP Blockers Similar and Different?
Reviewed by: HU Medical Review Board | Last reviewed: April 2023 | Last updated: September 2023
Migraine treatment options continue to expand. There are many different drug choices for the treatment and prevention of migraine. There are now 8 drugs approved by the US Food and Drug Administration (FDA) to treat migraine by blocking CGRP (calcitonin gene-related peptide). They are:1-8
CGRP blockers (also called inhibitors) are a newer class of drugs used to treat migraine. They work by blocking the action of CGRP, a protein that plays a role in transmitting pain signals. CGRP blockers have been shown to be effective in reducing the frequency and severity of migraine attacks.9
CGRP blockers are available as injections, nasal sprays, and oral drugs. Some are used to treat acute migraine attacks, while others help prevent chronic migraine.1-8
They offer hope to millions who live with the debilitating effects of migraine. These products, which target the CGRP process, work in different ways.9
What is CGRP?
CGRP is a protein. It is involved in:9
- The transmission of pain signals
- Inflammation
- Vasodilation (widening of blood vessels)
CGRP is released by neurons in the trigeminal nerve, which is the main nerve that carries pain signals from the head to the brain.9
What is the role of CGRP in migraine?
CGRP is thought to play a role in the development of migraine attacks. When CGRP levels are high, it can cause inflammation and pain. This can lead to the symptoms of a migraine attack, including:9
- Headache
- Nausea
- Vomiting
- Sensitivity to light and sound
How do CGRP blockers work?
There are 2 types of CGRP blocker drugs:10
The lock-and-key analogy helps explain how these drugs disrupt the CGRP process. The CGRP protein acts as the key. The protein's receptor (the area where CGRP works) acts as the lock.
Monoclonal antibodies (MAbs)
MAbs are lab-made proteins that mimic the antibodies our bodies produce. Antibodies are part of the immune system. They help to fight infection by binding to and destroying foreign substances (antigens). MAbs can be used to boost the immune system and help to fight infection.11
CGRP blocker MAbs target either the CGRP protein or its receptor. These drugs are injected under the skin or in a vein to prevent migraine attacks. As of March 2023, there were 4 CGRP blocker MAbs approved by the FDA:1-3,6,10
- Aimovig™ (erenumab-aooe)
- Ajovy™ (fremanezumab-vfrm)
- Emjality™ (galcanezumab-gnlm)
- Vyepti™ (eptinezumab-jjmr)
Gepants
Gepants block the CGRP receptor (the “lock”). They are taken as nasal sprays or pills. As of March 2023, there were 4 gepants approved by the FDA:4,5,7,8
How you can afford CGRP blockers
The cost of CGRP blockers can vary depending on:12
- The specific drug
- The dosage
- Your insurance
It is always best to talk to your doctor or pharmacist about your costs and how you can get the best price. Many drug companies offer coupons and discounts. You can find these coupons online or in your doctor's office.12
Are CGRP blockers right for you?
Whether or not CGRP blockers are right for you depends on many factors, including:10
- The severity of your migraine attacks
- The frequency of your migraine attacks
- Your medical history
- Your insurance coverage
Talk to your doctor about the risks and benefits of CGRP blockers before deciding whether they are right for you.
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