CGRP Migraine Treatments

What Is CGRP and Why Does It Cause Migraines?

Calcitonin gene-related peptide (CGRP) is a neuropeptide, produced in the nervous system and is a key molecule in transmitting pain signals. CGRP also causes blood vessel inflammation and is heavily involved in triggering migraine attacks.

How CGRP triggers a migraine

1. Trigeminal nerves release CGRP.

2. CGRP binds to receptors on blood vessels and nerve cells.

3. Blood vessels dilate and inflammatory signalling increases.

4. Pain signals travel from the trigeminal system to the brain stem and cortex.

5. Migraine symptoms develop - nausea, headache, sensitivity to light.

Regular migraine treatment, such as triptans, work by constricting the blood vessels, however, this means triptans are not suitable for use in some individuals who have a cardiovascular risk.

CGRP-targeting therapies take a different approach - they block the CGRP pathways which prevents the cascade that leads to the migraine.

Two Types of CGRP Treatment

CGRP Receptor Antagonists

CGRP receptor antagonists, such as Gepants, block the CGRP receptors and prevent migraines from occurring.

Examples include:

• Rimegepant (Vydura)

• Atogepant (Aquipta)

Gepants are effective and have a dual action; they can treat migraines but also prevent them. Other benefits include:

• Fast onset of action: Both rimegepant and atogepant begin to work within a few hours, helping to reduce migraine pain and associated symptoms.

• Targeted formulation: as CGRP receptor antagonists, they address one of the key biological drivers in migraine, rather than acting like a painkiller.

• Ease of use: Rimegepant simply melts on or under the tongue and atogepant is taken like a regular tablet.

Other treatments which target the CGRP receptor or CRGP itself are monoclonal antibodies. These include:

• Erenumab ( Aimovig)

• Fremanezumab (Ajovy)

• Galcanezumab (Emgality)

• Eptinezumab (Vyepti)

Monoclonal Antibodies (mAbs)

Monoclonal antibodies are only a preventative measure and are used once monthly or three injections every 3 months for Ajovy.

These need to be prescribed by a specialist and are usually reserved for migraines that are frequent or difficult to treat.

Monoclonal antibodies may be prescribed for you by your GP if:

• You have at least 4 migraine attacks per month AND

• You have tried 3 or more preventative medicines at the maximum doses you can tolerate for several months each, and they haven't worked.

• You have chronic migraines - 15 or more headache days a month with features of a migraine headache on at least 8 days per month - for more than 3 months.

CGRP Treatments Available in the UK

Current CGRP treatments available in the UK are outlined below:

Currently, only rimegepant is available privately via online pharmacies in the UK such as here at Quick Meds.

Clinical Evidence: How Effective Are CGRP Treatments?

Rimgepant studies show that 21% of patients are pain free within 2 hours after taking a dose.

The HALO studies showed that Fremanezumab produces ≥50% reduction in monthly migraines in ~40.6% of patients and quarterly migraines in 39.7% of patients. This led to significant improvements in quality of life and disability scores.

The ARISE trial showed that Erenumab produces ≥50% reduction in monthly migraines in ~40% of patients, compared to ~29% in placebo patients. This demonstrates a strong preventative benefit.

CGRP Vs Triptans - Who benefits the most?

Here is a comparison of the effectiveness of CGRPs and Triptans.

CGRP-targeting therapies may be particularly helpful for people who:

• Do not respond to triptans

• Experience side effects with triptans

• Require preventative migraine therapy

• Have cardiovascular health issues which prevent them using triptans

Triptans are effective but CGRP-targeting treatment is beneficial for those who have migraines which are hard to treat.

Who Should Consider CGRP Treatment?

CGRP treatments may be particularly helpful for people who:

• Do not respond to triptans - around 30% of migraine patients do not respond to triptans

• Experience side effects with triptans

• Need preventative migraine therapy

• Have cardiovascular conditions making it unsafe for them to use triptans

• Have chronic migraines or difficult to treat migraines

• Need treatment for menstrual migraines - some evidence suggests that gepants such as rimegepant can help with menstrual migraines

• Have hemiplegic migraines

If you think Vydura may benefit you, click here to start your consultation.

Side Effects and Safety

Gepants are generally well tolerated and side effects are usually mild. The most common side effects include:

• Constipation

• Fatigue

• Nausea

• Allergic reaction

Gepants should be avoided in:

• Hepatic impairment

• Pregnancy and breastfeeding - safety has not been established

If you are taking any other medications, let your prescriber know. Gepants can interact with some medicines such as antibiotics.

CGRP monoclonal antibodies are also generally well tolerated and side effects are usually mild. The most common side effects include:

• Constipation - particularly with erenumab

• Fatigue

• Itching

• Injection site reactions

Long-term safety trials for CGRP monoclonal antibodies demonstrate a favourable safety profile. Some studies have followed patients for up to 3 years with sustained safety and efficacy.

How to Get CGRP Treatment in the UK

• NHS route: GP referral → neurology → specialist prescription.

• Private/online pharmacy route: Vydura (rimegepant) via QuickMeds.

• Cost comparison.

• CTA: See if you qualify for Vydura.

CGRP treatments are available on the NHS, though, except for Vydura, require a referral to neurology. For this reason, many patients opt to obtain treatments from private providers such as Quick Meds.

Though the cost of treatment must be paid completely by the patient, private providers offer an advantage in that there is no waiting time for NHS referrals and treatment can be supplied by as soon as the next day.

To order Vydura, head to the migraine section on our website and fill out an online form. Following this, add Vydura to your basket and checkout. One of our GPhC-registered prescribers will then review your responses and, if approved, will dispatch usually on the same day.

Other CGRP treatments, such as atogetpant or monoclonal antibodies are restricted. These can only be supplied via a neurology referral.

Vydura is currently not widely available through most providers. Here at Quick Meds we strive to provide a variety of treatments to suit our patients’ needs. Below is a list of providers with a price breakdown.