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CGRP and migraine: from bench to bedside.

¹Department of Medicine, University Hospital, 22185 Lund, Sweden.

Revue Neurologique

|July 19, 2021

Summary

New migraine treatments targeting calcitonin gene-related peptide (CGRP) offer improved efficacy and fewer side effects. These therapies, including small molecules and monoclonal antibodies, represent a significant advancement in managing migraine pain.

Area of Science:

Neuroscience and Pharmacology
Migraine Pathophysiology
Trigeminal System Biology

Background:

Migraine treatment historically lacked targeted therapies for the trigeminal pain system.
Calcitonin gene-related peptide (CGRP) plays a crucial role in migraine pathophysiology.
Previous treatments had limitations in specificity and adverse event profiles.

Purpose of the Study:

To provide a historical overview of calcitonin gene-related peptide (CGRP) targeted migraine therapy development.
To discuss the biology of CGRP signaling within the trigeminovascular system.
To review the efficacy of CGRP-targeted treatments for acute and chronic migraine.

Main Methods:

Review of historical development of CGRP-targeted migraine therapies.

Keywords:

CGRP CLR CTR RAMPs Receptors

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Analysis of CGRP biology and its role in the trigeminovascular system.

Synthesis of current knowledge on CGRP antagonist and antibody efficacy.

Main Results:

Small molecule CGRP receptor antagonists (e.g., rimegepant, ubrogepant) are effective for acute migraine treatment.
Monoclonal antibodies targeting CGRP or its receptor are beneficial for prophylactic treatment of chronic migraine.
CGRP-targeted therapies demonstrate specificity and a favorable safety profile compared to older treatments.

Conclusions:

CGRP-targeted therapies represent a new era in migraine management, offering significant improvements.
These treatments are the first designed to specifically act on the trigeminal pain system.
Further understanding of CGRP signaling continues to advance migraine treatment strategies.