The World Health Organization recognizes migraines as one of the top 10 most disabling health conditions on Earth.
A migraine can stop you dead in your tracks. You can be going about your day normally, then out of nowhere you feel the pain start to pulsate. How do you stop a migraine? What medicine works to stop a migraine when you feel like you have tried just about everything with no luck? 2020 has been an unprecedented year for migraine suffers with several new migraine treatments gaining FDA approval. cGRPs modifiers and Ditans represent the newest medications approved to treat chronic migraines. This week we will focus on cGRP modifiers.
1. What is a cGRP Modifier?
To understand what a cGRP modifier does, you first have to understand what cGRP is. cGRP, or “calcitonin gene-related peptide” is a molecule produced in the body that is thought to cause changes in the brain blood vessels and trigger the release of chemicals in the body that promote and prolong headaches. cGRP modifiers are prescription medications that alter the amount of working cGRP in the body or interferes with cGRP activity.
2. What types of cGRP medicines exist?
The past 3 years have seen a big jump in new migraine treatment medications. There are currently 6 different cGRP modifying prescription drugs.
- Aimovig (erenumab)
- Ajovy (fremanezumab)
- Emgality (galcanezumab)
- Vyepti (eptinezumab)
- Ubrelvy (ubrogepant)
- Nurtec ODT (rimegepant)
Erenumab, fremanezumab, and galcanezumab are all injectable medications. These medications are given for prevention of migraines and are administered as an injection under the skin (i.e. subcutaneously). They are administered at home and some are once monthly, while others may be given once every 3 months. Eptinezumab is administered through an IV infusion in an infusion center and is given once every 3 months. All 4 of these medications are monoclonal antibody molecules.
Ubrogepant and rimegepant are not monoclonal antibodies, but are smaller molecules that can attach to cGRP receptor molecules in the body and render them inactive. If the cGRP receptor is inactive, that means cGRP cannot be successful at causing headache pain. Unlike the monoclonal antibody cGRP modifiers, these two medications are given as pills and are used for stopping an active headache (this is known as an abortive headache treatment). So these medications are not taken on a regular basis, only as needed.
3. What is a monoclonal antibody?
Monoclonal antibodies are designer drug molecules that mimic specific immune system antibodies. Antibodies are proteins that are part of our immune system and are responsible for “tagging” a molecule as a target for elimination by the immune system. Monoclonal antibodies used for migraine treatment tag either the cGRP molecule itself or the CGRP receptor and render them inactive. This reduces the capacity for cGRP to cause or prolong migraine headaches.
4. What should I know about cGRP medications?
Talk to your prescriber about these medications so that they can determine if you are a good candidate for this type of migraine treatment. The safety of mixing a preventative cGRP treatment with an abortive cGRP has not been determined at this time. These treatments can interact with certain medications and are not recommended for use in certain patients. The FDA label states that these medications should be avoided in patients with liver disease.
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This information is not medical advice and is solely for educational purposes. Consult your healthcare provider before making any health or medication decisions. Real Talk Health and it’s associates do not endorse/promote use of any medications or medical products mentioned on our website or blog posts or videos.