Mechanisms of therapeutic action of monoclonal antibodies to the calcitonin gene-related peptide (CGRP) ligand-receptor system in migraine

Migraine is one of the primary forms of headache, which affects at least 12% of the world's population. The current understanding of the pathogenesis of this cephalgia is based on the so-called trigeminovascular theory, within which the key role is given to the calcitonin gene-related peptide (CGRP), a neurotransmitter that plays an important role in the peripheral and central mechanisms of the migraine development. Long-term in-depth study of the pro-migraine properties of CGRP has led to the emergence of a fundamentally new class of drugs for the treatment of migraine, which includes CGRP receptor antagonists (gepants) and monoclonal antibodies (mAbs) that block either the peptide itself or its receptors (CGRPR). The review discusses in detail the pharmacodynamics of anti-CGRP/CGRPR-mAbs as prophylactic therapy for migraine, with an emphasis on the results of experimental studies performed on preclinical models of the disease.