How does the use of various CGRP inhibitors in the treatment of migraines compare to the use of other more common treatments such as antiepileptic drugs or beta blockers?

Abstract

Every year, nearly 40 million people in the United States experience the agony of chronic migraines (Migraine Editorial Team 1). Several possible remedies for migraines have been discovered to date, the most prominent ones include various antiepileptic drugs such as divalproex sodium and topiramate, as well as beta (Amiri et al., 2021)blockers such as propranolol and timolol. However many of these treatments are not entirely effective treatments for patients who face chronic migraines due to their somewhat prosaic success rates. In 1985, researchers noticed the presence of Calcitonin Gene-Related Peptide (CGRP) in the plasma increased drastically in its levels during the presence of a migraine attack (Deen et al. 2). CGRP is a neuropeptide that  is involved in the dilation of both dural and cerebral blood vessels, and this interaction is believed to be the main cause of migraines. Generally, when migraines are treated with triptans (a common symptom relief medication), CGRP levels in the blood generally reduce. It was further found that certain CGRP inhibitors reduced neurogenic inflammation and lead to an increased reduction of pain during the migraine (Deen et al. 4). When faced with a multitude of treatment options for chronic migraines, one must consider inhibitors of the CGRP pathway as a possible alternative. CGRP inhibitors introduce a possible better treatment option than previous medicinal drugs. A few previously used CGRP inhibitors include erenumab, galcanezumab, and fremanezumab, which have recently been used to treat patients of chronic migraines. In this paper we will consider the various CGRP inhibitors and their advantages and disadvantages in the face of conventional chronic migraine treatment options.