How Do CGRPs Work? Key and Lock Analogy

By Katie M. Golden

1 min read

During the 60th Annual American Headache Society (AHS) Scientific Conference in San Francisco, I had the distinct pleasure of sitting down with Dr. David Dodick, professor of neurology and a headache specialist at the Mayo Clinic in Phoenix, Arizona. In part one of this interview, Dr. Dodick discussed the importance of setting realistic expectations on how this new treatment - CGRPs, may reduce migraine frequency. In part two of our discussion, Dr. Dodick explains how CGRP antibodies function like a key and a lock and how future forms of this medication are also promising.

The good news and the bad news

Dr. Dodick candidly explains, "The bad news is you have maybe a 1 in 5 chance of not responding in the right way... The good news is there's more coming." Based on his key and lock analogy, there's hope for those who try the new treatment but may not respond to the "lock antibodies" as they may respond to the "key antibodies" that are developed in the future.

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Want to know how others living with migraine are doing with this new treatment? Check out the discussion in the forums section of the Migraine.com community.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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mixi Member
It's very encouraging to know that some new treatment will be available soon..... can't be soon enough 😉
wappaw Member
Just started Aimovig 11/8/2018. Hoping it will reduce the frequency of my migraines. I have been working in the yard which will normally cause shoulder, neck, and back pain; which triggers a migraine. So far the shoulder, neck, and back pain are present, but thankfully no migraine!
memphismama1 Member
I was on Aimovig for 4 months last summer with very little help. After a month to clear the Aimovig I have been on Ajovy for the last 3 months with even less help. Am wondering if I didn’t try the Aimovig long enough or should I try the Emgality? Would I have to clear the Ajovy to start the Emgality or restart the Aimovig? So glad to hear that there is more coming!!
1. Holly Harding Moderator & Contributor
 <inline-mention username="rosie716" user-id="3867740"/> Yes- the hurt that we feel when we hear how the migraine condition we have is impacting others and letting them down can be hard. It helps to take care with how we receive/talk about/ and frame it. If you notice, I said above that it can be upsetting when we hear how the migraine condition we have is impacting others- rather than saying "it hurts when we let our loved ones down." Or "it's hard when our migraine condition lets others down." Being careful to talk about migraine as a condition we have but never chose- that we are doing our best to manage - and not as a condition that is not who we are - can make a difference in how we feel and internalize things. That in turn can change how we project our feelings about it and how it is received. It's wonderful that your family is beginning to understand. I'm betting that is just not magically happening but due to your own gentle and careful educating and awareness-raising efforts gradually over time. Helping them to see the condition as a complex neurological disease that requires constant managing and not just a headache- this is a long process that sometimes takes years. So, your friends will take their own time to educate in time. For me, it has helped to send articles that resonated powerfully with me - along to friends and family to help them better understand what I'm up against. In doing so, they also see that I'm one of many who have this condition. I wonder what are some of the strategies you have used to help others understand and have compassion about migraine? So glad you're with us. Warmly- Holly <a href='https://-migraine.com' target='_blank' rel='noopener noreferrer ugc'>-migraine.com</a> team. 
2. Sawyer Matheny Moderator & Contributor
 <inline-mention username="rosie716" user-id="3867740"/> I know how hard it is to deal with that burden of the group bummer. We want nothing more than to please others and have some really great quality time, but it doesn't always work out. I wish folks would give us the benefit of the doubt. If somebody has the flu, people would completely understand if they can't make an event or hangout! It's internal struggle that's so hard for people to truly empathize. I hope that your friends come around soon and know that you have the best of intentions. I read somewhere recently that friends are formed in good times and family is formed in bad ones. Know you're not alone in this and we're here for you along your migraine journey. Thank you so much for being a part of our community 💜. Wishing you a gentle and symptom-free day ~ Sawyer (team member)
lesleyb Member
I started Ajovy in Dec. Had some immediate results, second month even better. Am on 3rd month now. Went from 26-28 migraines a month to 10, then 6. Now I only get them with extreme weather changes. Am due to try the Gammacore for the 6 or so I still get on Monday. Am hopeful with all these new treatments coming out.
tlocker Member
I started on Aimovig six months ago and after 21 years of severe migraine had FABULOUS response; from 8-15 days/month to 2-4, and overall severity much lower. I felt like I had my LIFE back! But NOW my BC/BS Caremark/CVS pharmacy has decided they will no longer cover this one med (appeals denied 2x), and the "Ally" Amiovg program won't help. So I am STUCK on an at LEAST three to six month journey to 'clear' current meds and am required to 'fail' on the other new ones before a possible return to the one that IS working. STUPID STUPID STUPID. Ask which meds your pharmacy covers BEFORE trying one, but know that's no guarantee.
CommunityMember1550 Member
HI I live in india and these CGRP drugs got introduced during the last 1 year. I am a bit scared to take these drugs as i found very little clinical trials conducted. I would like to have the feedback of my friends inthis group who have been taking this or taken this and stopped. My primary concerns is on the long terms effects if any noticed so far? Really appreciate your inputs.
1. Holly Harding Moderator & Contributor
 <inline-mention username="CommunityMember1550" user-id="4823050"/> This is such a valid concern and one shared by many in our community. I wrote an article about feeling like we're forced into being guinea pigs as we are desperate for solutions with very little data to show long-term impact of these treatments: <a href='https://migraine.com/living-migraine/trying-new-medications-cgrp' target='_blank'>https://migraine.com/living-migraine/trying-new-medications-cgrp</a>. As to wanting to read feedback of those who have tried these treatments, we do have forums dedicated to each drug that gather feedback regarding symptoms and efficacy. It depends on which specific medication you might be interested in researching as these forums are divided by specific drug (Emgality, AImovig, Ubrevly, etc). A way for you to search this information for yourself would be to go to our search bar above and type in the name of each drug individually and see all the articles that appear. Here's what appears for Emgality, for instance: https://migraine.com/search?s=emgality%20forum. A lot of firsthand accounts from members who use or have tried that medication. I hope that helps you as you continue thinking about this. Thanks for reaching out. Warmly- Holly <a href='https://-migraine.com' target='_blank' rel='noopener noreferrer ugc'>-migraine.com</a> team.
rosie716 Member
I think this all shows how we are all different and will need to try different medications to find what works for us. We need to move on and try another med when something doesn't work for us/stops working. We are all different.
1. Holly Harding Moderator & Contributor
 <inline-mention username="rosie716" user-id="3867740"/> Such a great point! All bodies are different and that's why finding a solution for migraine is so challenging and must be individualized. Often it takes a multi-pronged approach to find relief. It's also good for us to be considerate about this point and not judge others who don't have success with a treatment that has worked for us (another reason I appreciate what you wrote). Thank you for sharing- so glad you're with us. Warmly- Holly <a href='https://-migraine.com' target='_blank' rel='noopener noreferrer ugc'>-migraine.com</a> team. 
2. Kimberly.broughal Moderator
 <inline-mention username="rosie716" user-id="3867740"/> You've hit it on the nail. Everyone is on their own unique journey. I find it so helpful to hear from other people's experiences. When I read your post, I immediately thought to myself wow we have pretty similar stories with CGRP's. I have tried both Emgality and Ajovy. I did not find success with either of those and moved onto Vyepti. After starting this, my average pain level went down about one notch which was HUGE, for me anyway. Unfortunately, I just don't feel like it's doing much anymore which is certainly discouraging but you've been in that same boat and know how it feels. I had a Vyepti Infusion about a week ago and if after this round it stays stagnant it is indeed time for me to move on. It's interesting that we both had success with Vyepti and that it eventually tapered off. It's great to hear that you've got the Ubrelvy and Sumatriptan that do work for you. I really hope the Qulipta becomes another tool in your toolbox. I am sending positive thoughts your way! In solidarity, -Kim (Migraine.com Team Member)
rosie716 Member
Thank you, Holly for your kind words!
rosie716 Member
Holly, I was told by my Migraine PA that these meds just stop working because we have reached our tolerance and they no longer help. Then we need to pursue a different med.
1. Holly Harding Moderator & Contributor
 <inline-mention username="rosie716" user-id="3867740"/> Oh, isn't that interesting! I've had yet to hear any reasoning for why the CGRPs stop working in their tracks. Thank you for sharing this take. I know that is the case with opioids and other types of meds to which we can build a tolerance- but hadn't heard that could happen with CGRPs. Fascinating. Warmly- Holly <a href='https://-migraine.com' target='_blank' rel='noopener noreferrer ugc'>-migraine.com</a> team.