Migraines and CGRP Monoclonal Antibodies: A Review of Cardiovascular Side Effects and Safety Profile

Abstract

Migraine headaches are a common complaint described by patients and few medications have been designed solely for their treatment. Current knowledge of migraine pathogenesis relates to various neuropeptides, including calcitonin gene related peptide (CGRP), acting on blood vessels within the brain, causing vasodilation. Sensory fibers detect this change and perceive it as pain. This understanding has led to the development of CGRP monoclonal antibodies as a possible migraine treatment. This class of migraine medication causes concern for possible cardiovascular side effects. Blocking CGRP and the vasodilatory process of migraines may pose a risk for exacerbating cardiovascular disease. CGRP has also demonstrated protective effects on the cardiovascular system by preventing against heart failure, deleterious cardiac remodeling, hypertension, and cell death. Additionally, patients with migraines are also believed to be at greater baseline risk for cardiovascular and cerebrovascular disease. Assessment of a cardiovascular risk profile is essential for the continued use of this medication class. Various trials within phase II or III of study were analyzed for the risk profiles of CGRP monoclonal antibodies. At this time, no serious cardiovascular adverse effects have been found. The CGRP monoclonal antibodies did not increase rates of cardiovascular adverse events, when compared to placebo. The CGRP monoclonal antibodies were shown to be safe in patients with previous cardiovascular risk as well as those stressed to provoke an adverse cardiovascular event. Many of the phase II and phase III trials had significant female participation, representing a safe cardiovascular profile for those most commonly affected with migraines. This demonstrated that the medication class does not increase risk of cardiovascular side effects in its users.