Our 2024 Migraine State of the Union featured some of the most exciting news of the year for people living with migraine. Learn how newly published guidance on the use of promising CGRP-targeting therapies will impact migraine treatment and prevention.
FDA-approved calcitonin gene-related peptide (CGRP)-targeting therapies have been available to treat migraine since 2018, but many people have difficulty accessing these potentially powerful treatments. Often someone is required to first try a number of other, less effective options before CGRP-targeting therapies are made available.
However, earlier this year the American Headache Society (AHS) published a position statement updating its stance on the use of CGRP-targeting therapies as first-line treatments for people with migraine. This is huge news for people struggling to find a migraine treatment plan that works for them, who may soon have greater (and quicker) access to a range of migraine treatment and prevention options.
During our 2024 Migraine State of the Union, Christine Lay, MD, FAHS, Chair of the American Migraine Foundation moderated a webinar featuring panelists Nim S. Singh, MPH, AMF Vice Chair; Rashmi Halker Singh, MD, FAHS, FAAN, Associate Professor of Neurology at Mayo Clinic; Kathleen Digre, MD, former AHS President and Professor of Neurology and Ophthalmology at the University of Utah; and Lindsey des los Santos, Patient Advocate. Their discussion broke down the new consensus position statement published by AHS, as well as the latest advancements, challenges, and solutions in managing migraine
Below, learn more about what AHS’s new position on CGRP-targeting therapies means for healthcare providers and people living with migraine.
CGRP-Targeting Therapies: A New Option for First-Line Migraine Treatment and Prevention
With its newly published statement, AHS now supports the use of CGRP-targeting therapies as a first-line treatment option for migraine. This new guidance marks a change from previous positions that providers should try a range of existing preventive migraine treatments before prescribing CGRP-targeting therapies.
Because CGRP-targeting therapies are still relatively new, AHS formed a task force to better understand their impact on migraine treatment. The task force reviewed evidence from every available migraine clinical trial and published study about CGRP, specifically looking at the effectiveness, safety, side effects and cost of CGRP-targeting migraine treatments.
The result?
“CGRP monoclonal antibodies should really be a first-line trial for any prevention of migraine,” Dr. Digre says. “There’s so much evidence that it’s safe, it’s effective and the side effect profile is way better. It really made a difference in our patients’ lives.”
The task force found that CGRP-targeting therapies should be available as a first treatment option for people who experience more than 4 migraine days per month. This means people living with migraine may no longer be forced to try other classes of preventive treatment before being able to use CGRP-targeting therapies.
What Are CGRP-Targeting Therapies?
CGRP is a protein involved in transmitting pain signals to the brain, including the intense head and neck pain often experienced during a migraine attack. By targeting CGRP molecules or the CGRP nerve receptors that send pain signals to the brain, anti-CGRP therapies are able to reduce pain, ease migraine symptoms and prevent attacks.
Migraine treatments that target CGRP are divided into two main types: monoclonal antibodies (erenumab, fremanezumab, galcanezumab, and eptinezumab), which target the CGRP receptor or ligand, and are given as injections, and oral medications like gepants (rimegepant and atogepant) that prevent CGRP molecules from attaching to pain receptors. The new AHS guidance considers both of these under the umbrella of CGRP-targeting therapies for migraine.
Enabling More Personalized Migraine Treatment Plans
Possibly the biggest impact of AHS’s new statement is that it introduces more options for providers to tailor migraine treatment plans to an individual patient’s needs.
“What we are hoping to do with this position statement is elevate the CGRP targeted treatments as a first line option. Not the first line option, but a first line option.” Dr. Halker Singh said.
As anyone who has struggled to manage their migraine knows, finding the right treatment plan is an often frustrating process of trial and error. If someone who benefits from CGRP-targeting therapies can start these treatments at the beginning of their migraine journey, it could save them from needless pain, suffering and days lost to migraine.
“Before this update, I might say to a patient, ‘Based on what I know about your life and your expectations, this medicine might be the best choice, but your insurance company requires that you try these other treatments first,'” says Dr. Halker Singh. “Now I can remove that barrier and really think about the needs of the individual patient in front of me.”
Fewer Side Effects and More Targeted Migraine Treatment
All current first-line preventive treatments for migraine are medications that were originally developed for other conditions — such as antidepressants and anti-seizure drugs — and later found to be effective at treating migraine. Many of these medications have undesirable side effects, and whether they work to treat migraine symptoms varies significantly from person to person.
CGRP-targeting therapies, on the other hand, are the first medications developed specifically for migraine. “What’s so exciting about the CGRP monoclonal antibodies and gepants is that these are migraine-specific therapies. They’re attacking the disease itself,” Dr. Digre says.
People often end up going off current preventive treatments due to side effects or because the treatment is not effective. However, because CGRP-targeting therapies have fewer side effects than current first-line migraine medications, people tend to stay on these treatments much more consistently than other preventive treatment options. Fewer side effects and higher likelihood of sticking with a treatment plan can mean better overall management of migraine symptoms.
Promoting Migraine Advocacy, Education and Community
The AHS’s incredible work assembling so much clinical research in this single published report will have a major impact on patient advocacy. AMF Vice Chair Nim Singh hopes both providers and patients will be able to use the position statement to advocate for earlier access to CGRP-targeting therapies, and to investment in migraine research and policy changes for how migraine care is administered.
“This is a really critical opportunity to leverage this concise information,” says Singh. “The position statement is easy to read, it’s understandable and it lends itself to policy change.”
The position statement is also a powerful resource in service of our mission to mobilize a community for patient support and advocacy. Often people living with migraine struggle to find the resources they need to find treatment, advocate for themselves at the doctor and feel supported by others who understand what they’re going through.
“With the community we’re providing through AMF and our partner organizations, people now have a go-to place to call, email or reach out to say, ‘I’m talking to my provider or my insurance and they’re still not getting it. What can I do?'” Singh says. “We’re able to provide that support and community they may not have had before.”
Reducing Migraine Burden and Hope for the Future of Treatment
Migraine and headache disorders were found to be the third largest cause of years lived with disability (YLD) in the 2019 Global Burden of Disease Study, and disability due to migraine is estimated to cost U.S. employers $13 billion a year. However, the new AHS position statement offers hope that with greater access to CGRP-targeted therapies, we can greatly reduce this overall burden of migraine and its impact on people’s lives.
“With these targeted therapies, migraine attacks are less frequent, they’re less severe, they’re shorter in duration and, really importantly, people talk about having clear headache-free days,” says Dr. Lay. “They never realized what a headache-free day was until they got on these therapies.”
During the 2024 Migraine State of the Union, Lindsey des los Santos, one of our incredible Emerging Advocates, spoke about the often overwhelming burden of migraine and how education and advocacy around these new treatments are offering hope.
“Migraine has impacted every area of my life, but we are fortunately finding things that are working. I think this is why advocacy is so important — the stories we tell will make a difference,” says des los Santos. “You really have to advocate for yourself. This is not always an easy road to travel, but knowing the American Migraine Foundation has talking points and additional support is so encouraging.”
You can read AHS’s full position statement on CGRP-targeting therapies here.
