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Dr Bronwyn Jenkins
Migraine prophylaxis is likely to be improved by a new wave of monoclonal antibody-based treatments that act on calcitonin gene related peptide (CGRP), according to a ‘headache update’ presentation at ANZAN 2019.
Dr Bronwyn Jenkins, a consultant neurologist in Sydney with a special interest in headache, said it had taken more than 30 years since the discovery of CGRP in 1982 to have the first anti-migraine prophylactics ready for clinical use.
Early research had shown that CGRP levels were increased in migraine, including in the trigeminalcervical nucleus. CGRP infusion triggered migraine and that sumatriptan normalised CGRP levels.
In more recent times, three CGRP-targeted monoclonal antibody agents had been developed: erenumab against the CGRP receptor and fremanezumab and galcanezumab which act against the CGRP neurotransmitter itself.
The three agents are usually given subcutaneously on a monthly basis, and in randomised controlled trials they had shown significant preventive effects against chronic migraine. With erenumab, for example, the proportion of patients showing more than a 50% response rate in chronic migraine was double that of placebo, Dr Jenkins noted.