CGRP-blocking drugs are the biggest advance in migraine treatment in decades

Full analysis

A class of drugs called CGRP antagonists — targeting calcitonin gene-related peptide (CGRP), a chemical messenger released during migraine attacks — has significantly changed treatment for many patients. Brian Grosberg describes two forms: large monoclonal antibodies (injected monthly at home or infused quarterly in a clinic) and smaller oral or nasal-spray molecules called gepants. The injectable antibodies work in roughly 60% of patients, with some seeing benefit within the first month and others taking three to four months; 'success' includes at least a 50% reduction in headache days. Failing one drug in the class does not predict failure with another, since different molecules bind differently. These drugs are expensive — potentially thousands of dollars a year — and insurance coverage is variable and often requires prior failure of older preventive medications first. Grosberg calls them the most significant change he has seen in his clinical practice.