CGRP therapy in primary care for migraine: prevention and acute medication

Migraine affects about one in seven people worldwide 1 and is the leading cause of disability among people aged under 50 years, often impacting negatively on education, employment, and family relationships. 2 The discovery of calcitonin gene-related peptide (CGRP) as a key player in migraine pathophysiology, and the subsequent development of drugs that target this system, represents a triumph in bench-to-bed medicine and has revolutionised both migraine prevention and acute medication strategies. 3CGRP therapies have been shown to be highly effective at reducing migraine and overall are said to benefit at least 50% of patients by at least 50%. 4,5Guidance issued by the Medicines and Healthcare products Regulatory Agency states that topiramate, a commonly used migraine preventive in primary care, is now contraindicated in pregnancy and under the 'Pregnancy Prevention Programme', 6 and furthers the need for new alternatives to be made available in primary care.Sooner or later most GPs will be in the position to prescribe some form of CGRP therapy.Knowledge of these drugs and when to prescribe them is briefly reviewed below.