CGRP Guideline Update!
- Sam U
- Apr 18, 2024
- 2 min read
The American Headache Society (AHS) has issued a new position statement updating their clinical recommendations on migraine preventive treatments. Through this update, the AHS now endorses CGRP-targeting therapies as a first-line option for migraine prevention, on par with older medications like topiramate, propranolol, and amitriptyline.
CGRP (calcitonin gene-related peptide) is a molecule that plays a key role in the biological mechanisms underlying migraine attacks. Several new migraine medications have been developed that either block CGRP itself or block the receptor that CGRP binds to. These include the injectable antibody treatments erenumab, fremanezumab, galcanezumab, and eptinezumab, as well as the oral CGRP antagonists rimegepant and atogepant.
In their previous guidance, released in 2018, the AHS recommended that patients try at least two conventional preventive medications before being offered CGRP therapies. However, their updated statement removes this requirement based on the substantial recent evidence accumulated demonstrating the superior efficacy, safety, and tolerability of the CGRP medications compared to older migraine prevention drugs.
The statement cites the many pivotal clinical trials showing that CGRP therapies significantly reduce monthly migraine days in both episodic and chronic migraine. Side effect profiles are minimal, and adherence is high for the CGRP class as a whole. Real-world observational studies have corroborated these benefits in clinical practice across diverse patient populations.
CGRP drugs are the first to be developed and explicitly FDA-approved for migraine prevention, unlike older medications that were repurposed from other diseases like hypertension, seizures, or depression. As migraine-specific drugs, the CGRP therapies do not have the same contraindications or side effect risks as many traditional preventives.
The AHS statement acknowledges the higher upfront costs of the CGRP drugs but argues their clinical benefits and potential to reduce overall healthcare utilization may offset these costs over time. It encourages insurance companies and health systems to lower barriers to access them as first-line options for appropriate patients.
While not going so far as to declare CGRP therapies the preferred first-line option, this statement is a significant step forward in prioritizing these modern, migraine-specific preventatives.
For millions of people with migraine who struggle with prevention due to lack of efficacy or intolerable side effects from older drugs, having a more straightforward clinical path to trying CGRP therapies as an early option could be transformative in improving outcomes and quality of life.
View the full statement here:
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