Profiling galcanezumab in episodic migraine, cluster headache, and medication overuse headache

The introduction of monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway has revolutionized migraine treatment. In this regard, galcanezumab, a humanized immunoglobulin G4 (IgG4) that binds the CGRP molecule, has rapid onset of action, monthly dosing, and favorable pharmacokinetics.

This review, which draws upon electronic databases such as PubMed, Web of Science, FDA, and EMA, provides a comprehensive summary of galcanezumab for migraine prophylaxis. It covers the drug's mechanism of action, its clinical efficacy in episodic migraine, and its potential benefits in episodic cluster headache and medication-overuse headache. It also provides an overall safety profile based on clinical trials and real-world studies.

Galcanezumab is a cornerstone preventive therapy with consistent efficacy, favorable tolerability, and convenient dosing. Key unmet needs include identifying biomarkers to predict responders, addressing access and cost barriers, optimizing evaluation windows for late-responders, and expanding the evidence base for special populations (pediatrics, pregnancy, and vascular comorbidities). Future studies should refine patient selection and explore complementary targets for non-responders.