CGRP Inhibitors

What are CGRP inhibitors?

CGRP inhibitors are prescription medications that treat migraine headaches.

Your healthcare provider may suggest a CGRP inhibitor if you experience chronic migraines. They can also treat occasional (episodic) migraines, too.

How do CGRP inhibitors work?

CGRP inhibitors get their name from how they prevent migraines. Inhibit means to stop or slow down.

CGRP stands for calcitonin gene-related peptide. Normally, CGRP is a helpful protein. It helps control your blood pressure by expanding your blood vessels (vasodilation).

But if you have migraines, your body creates extra CGRP. This excess CGRP activates nerves in your brain that make pain signals worse. It can also make pain last longer. CGRP inhibitors stop this before it can happen.

There are two types of CGRP inhibitors.

CGRP monoclonal antibodies

Monoclonal antibodies (moAbs) are proteins made in a lab. They act like the antibodies your immune system uses to fight off invaders. But instead of fighting germs or other foreign substances, they target specific cells in your body. They’re like an army of security robots that automatically target and destroy extra CGRP in your blood.

Examples of monoclonal antibody CGRP inhibitors include:

• Eptinezumab
• Erenumab
• Fremanezumab
• Galcanezumab

Eptinezumab is an intravenous (IV) infusion your provider will inject into one of your veins. You’ll need an infusion every three months.

The other three are injections that go put under your skin (subcutaneously). You’ll give yourself the injections at home once a month. Your provider will teach you how. Some people who use fremanezumab only need four injections a year. Your provider will tell you which medication is best for you and why.

CGRP receptor antagonists (gepants)

CGRP receptor antagonists block the receptors in your brain that CGRP binds to.

It’s like a game of musical chairs. The medication steals seats CGRP would normally fill — the receptors on your nerves. If the receptors are filled, CGRP can’t bind to your nerves and trigger pain signals.

Examples of CGRP receptor antagonists include:

• Atogepant (a pill you take by mouth every day)
• Rimegepant (a pill you dissolve under your tongue)
• Ubrogepant (a pill you take by mouth)
• Zavegepant (a nasal spray you put in your nose)

CGRP receptor antagonists may also manage migraine symptoms after one has started. Your healthcare provider will tell you if it’s safe to take one to treat symptoms. Atogepant is the only daily pill that can help you prevent migraines.

What are the benefits of CGRP inhibitors?

CGRP inhibitors are the first medications designed to directly treat and prevent migraines.

Taking a CGRP inhibitor can:

• Reduce how often you experience migraines
• Make the migraines you do experience shorter and milder
• Prevent some migraines completely

What are CGRP inhibitor side effects?

CGRP inhibitor side effects can include:

• Back pain
• Constipation or diarrhea
• Dry mouth
• Feeling tingling, numbness or pins and needles (paresthesia)
• Joint pain
• Nausea and vomiting
• Non-migraine headaches
• Pain or reactions at the injection or infusion site

Severe complications are rare, but can include:

• High levels of liver enzymes (transaminitis)
• Liver damage
• Vision issues

Call your healthcare provider if you experience any side effects.

How soon will I feel better?

It can take a month or two to start feeling better. How soon you’ll notice improvements depends on a few factors, including:

• Which CGRP inhibitor you need
• How often you experience migraines
• How severe the migraine symptoms you experience are
• Your overall health

Your healthcare provider will explain which CGRP inhibitor they think is right for you. They’ll help you understand what to expect and when you should start seeing changes.

When should I see my healthcare provider?

You’ll need checkups with your healthcare provider after starting a CGRP inhibitor. They’ll want to make sure the medication is helping. Let them know if you’re having fewer migraines and/or less severe symptoms. Tell your provider about any side effects you’re experiencing.

You might need to see your provider for infusions. Ask your provider if you have questions about how to give yourself your injections at home.