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New drugs for migraine prophylaxis

Less of a headache?

The discovery of the role of ‘calcitonin gene-related peptide’ (CGRP) in the development of migraine enabled new drugs for the treatment of this condition to be developed. The monoclonal CGRP antagonists erenumab, fremanezumab and galcanezumab have now been authorized for migraine prophylaxis. These drugs are just as effective as those used so far, like propranolol, metoprolol, topiramate, valproic acid and botulin toxin type A. With these new drugs, the proportion of patients experiencing more than 50% reduction in the number of migraine days per month increases by a factor of about 2.5, from about 20 to about 50 per 100 patients. The CGRP antagonists, which are injected once a month or once every three months, have fewer adverse effects than the drugs used so far. New migraine guidelines propose using the CGRP antagonists for patients in whom more than two traditional preventive therapies have failed. The new drugs are, however, very expensive compared to those used so far, and are therefore reimbursed by insurers only for a specific target group.

  • Like the traditional drugs for migraine prophylaxis, the CGRP antagonists erenumab, fremanezumab and galcanezumab reduce the number of migraine days per month by one to two.
  • The CGRP antagonists have fewer adverse effects than the traditional drugs for migraine prophylaxis, resulting in fewer patients discontinuing the treatment.
  • One limitation of the research into these new drugs is that the results have mostly been obtained in indirect comparative studies.
  • The new drugs are expensive (about € 6,000/year) and are conditionally reimbursed by insurers for patients with therapy-resistant chronic migraine.
  • As an addition to the traditional drugs for migraine prophylaxis, the CGRP antagonists constitute an alternative for patients with therapy-resistant chronic migraine.

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  • Erik P. Schwarz