Six CGRP-targeting therapies — four monoclonal antibodies and two gepants — are now available for preventive migraine treatment, offering strong efficacy with favorable safety profiles.
6 approved drugsCGRP-targeted medications now available for preventive migraine treatment — four injectable antibodies and two oral gepants, all introduced since 2018
What the researchers found
Six drugs targeting CGRP are now approved for preventive treatment of episodic migraine in adults: four monoclonal antibodies (eptinezumab, erenumab, fremanezumab, galcanezumab) and two gepants (rimegepant, atogepant). The monoclonal antibodies and atogepant have demonstrated effectiveness for both episodic and chronic migraine. All CGRP-targeted therapies show favorable safety and tolerability profiles.
These therapies have enabled new paradigms for migraine prevention, moving beyond older drugs that were repurposed from other conditions toward purpose-built treatments designed specifically around the CGRP peptide pathway.
Why it matters
Migraine affects over 1 billion people globally and was historically treated with preventive medications borrowed from other conditions (blood pressure drugs, antidepressants, anti-seizure medications) that often had significant side effects. CGRP-targeted therapies represent the first class of medications designed specifically for migraine, targeting the peptide pathway now known to play a central role in migraine pathophysiology.
How the study worked
This is a clinical review article published in Continuum, a continuing medical education journal of the American Academy of Neurology. It synthesizes clinical trial evidence and clinical experience with CGRP-targeted therapies for migraine prevention, providing a comprehensive overview for practicing neurologists.
What this study cannot tell us
As a review article, this does not present new primary data. The article focuses primarily on CGRP-targeted therapies and may not provide equal coverage of all available preventive migraine treatments. Long-term safety data beyond a few years is still accumulating for these relatively new medications. Cost and access remain barriers for many patients.
How to read the evidence
This is a clinical review synthesizing evidence from multiple randomized controlled trials. While it does not generate new data, the individual CGRP-targeted therapies it reviews have strong RCT evidence supporting their efficacy. The review provides a high-quality clinical synthesis for practicing physicians.
When this study was published
Published in 2024, this review covers the current state of CGRP-targeted migraine prevention including all agents available as of publication. The field continues to evolve rapidly.
The bigger picture
The success of CGRP-targeted therapies is one of the most significant examples of peptide biology translating into transformative clinical medicine. The rapid development and adoption of multiple CGRP-targeting drugs since 2018 validates the concept that targeting specific neuropeptide pathways can yield effective, well-tolerated treatments for neurological conditions — a model that could be applied to other neuropeptide-driven disorders.
Questions still open
- How do the different CGRP-targeting approaches (antibodies vs. gepants) compare in long-term effectiveness and patient preference?
- Will combination approaches using CGRP therapies with other preventive treatments provide additional benefit for treatment-resistant migraine?
- Can CGRP-targeted therapies be personalized based on individual patient biomarkers or migraine subtypes?
Common questions
What is CGRP and why is it important in migraine?
What is the difference between monoclonal antibodies and gepants for migraine?
Read the original research
Preventive Treatment of Migraine.
Continuum (Minneapolis, Minn.), 30(2), 364-378
Citation
Lipton, Richard B. (2024). Preventive Treatment of Migraine.. Continuum (Minneapolis, Minn.), 30(2), 364-378. https://doi.org/10.1212/CON.0000000000001418