Calcitonin gene-related peptide-targeted therapies for migraine.

Calcitonin gene-related peptide (CGRP)-targeted therapies are the first medications developed specifically for migraine prevention. They block the actions of CGRP, a neuropeptide with a key role in migraine pathophysiology. There are 2 categories of drugs: monoclonal antibodies directed against either the CGRP ligand or receptor, and small-molecule CGRP receptor antagonists. CGRP monoclonal antibodies are available as self-administered subcutaneous injections or as an intravenous infusion, and are administered monthly or quarterly. Clinical trial and real-world data over the past 10 years support their effectiveness and safety in patients with episodic and chronic migraines, and research into long-term safety is ongoing. Patients must fulfil certain criteria, including prior treatment with nonspecific oral preventive medications, to receive subsidised treatment with these drugs on the Pharmaceutical Benefits Scheme (PBS) in Australia. Small-molecule CGRP receptor antagonists (known as gepants) are orally administered drugs that can be used for migraine prevention or acute treatment. There are no gepants listed on the PBS at the time of writing. Their role in the prevention and acute treatment of migraine is continuing to evolve.