Top

Published in:

Open Access 01-12-2017 | Review article

Blocking CGRP in migraine patients – a review of pros and cons

Authors: Marie Deen, Edvige Correnti, Katharina Kamm, Tim Kelderman, Laura Papetti, Eloisa Rubio-Beltrán, Simone Vigneri, Lars Edvinsson, Antoinette Maassen Van Den Brink, On behalf of the European Headache Federation School of Advanced Studies (EHF-SAS)

Published in: The Journal of Headache and Pain | Issue 1/2017

Abstract

Migraine is the most prevalent neurological disorder worldwide and it has immense socioeconomic impact. Currently, preventative treatment options for migraine include drugs developed for diseases other than migraine such as hypertension, depression and epilepsy. During the last decade, however, blocking calcitonin gene-related peptide (CGRP) has emerged as a possible mechanism for prevention of migraine attacks. CGRP has been shown to be released during migraine attacks and it may play a causative role in induction of migraine attacks. Here, we review the pros and cons of blocking CGRP in migraine patients. To date, two different classes of drugs blocking CGRP have been developed: small molecule CGRP receptor antagonists (gepants), and monoclonal antibodies, targeting either CGRP or the CGRP receptor. Several trials have been conducted to test the efficacy and safety of these drugs. In general, a superior efficacy compared to placebo has been shown, especially with regards to the antibodies. In addition, the efficacy is in line with other currently used prophylactic treatments. The drugs have also been well tolerated, except for some of the gepants, which induced a transient increase in transaminases. Thus, blocking CGRP in migraine patients is seemingly both efficient and well tolerated. However, CGRP and its receptor are abundantly present in both the vasculature, and in the peripheral and central nervous system, and are involved in several physiological processes. Therefore, blocking CGRP may pose a risk in subjects with comorbidities such as cardiovascular diseases. In addition, long-term effects are still unknown. Evidence from animal studies suggests that blocking CGRP may induce constipation, affect the homeostatic functions of the pituitary hormones or attenuate wound healing. However, these effects have so far not been reported in human studies. In conclusion, this review suggests that, based on current knowledge, the pros of blocking CGRP in migraine patients exceed the cons.

Edvinsson L (1985) Functional role of perivascular peptides in the control of cerebral circulation. Trends Neurosci 2:2–7

Goadsby PJ, Edvinsson L (1993) The trigeminovascular system and migraine: studies characterizing cerebrovascular and neuropeptide changes seen in humans and cats. Ann Neurol 33:48–56. doi:10.1002/ana.410330109 CrossRefPubMed

Goadsby PJ, Edvinsson L (1994) Peripheral and central Trigeminovascular activation in cat is blocked by the serotonin (5HT)-I D receptor agonist 311C90. Headache J Head Face Pain 34:394–399. doi:10.1111/j.1526-4610.1994.hed3407394.x CrossRef

Lassen LH, Haderslev PA, Jacobsen VB et al (2002) CGRP may play a causative role in migraine. Cephalalgia 22:54–61. doi:10.1046/j.1468-2982.2002.00310.x CrossRefPubMed

Uddman R, Edvinsson L, Ekman R et al (1985) Innervation of the feline cerebral vasculature by nerve fibers containing calcitonin gene-related peptide: trigeminal origin and co-existence with substance P. Neurosci Lett 62:131–136. doi:10.1016/0304-3940(85)90296-4 CrossRefPubMed

Edvinsson L (2015) CGRP receptor antagonists and antibodies against CGRP and its receptor in migraine treatment. Br J Clin Pharmacol 80:193–199. doi:10.1111/bcp.12618 CrossRefPubMedPubMedCentral

Eftekhari S, Warfvinge K, Blixt FW, Edvinsson L (2013) Differentiation of nerve fibers storing CGRP and CGRP receptors in the peripheral trigeminovascular system. J Pain 14:1289–1303. https://doi.org/10.1016/j.jpain.2013.03.010 CrossRefPubMed

Eftekhari S, Edvinsson L (2010) Possible sites of action of the new calcitonin gene-related peptide receptor antagonists. Ther Adv Neurol Disord 3:369–378. https://doi.org/10.1177/1756285610388343 CrossRefPubMedPubMedCentral

MaassenVanDenBrink A, Meijer J, Villalón CM, Ferrari MD (2016) Wiping out CGRP: potential cardiovascular risks. Trends Pharmacol Sci 37:779–788. https://doi.org/10.1016/j.tips.2016.06.002 CrossRefPubMed

10.

Schou WS, Ashina S, Amin FM et al (2017) Calcitonin gene-related peptide and pain: a systematic review. J Headache Pain 18:34. doi:10.1186/s10194-017-0741-2 CrossRefPubMedPubMedCentral

11.

Edvinsson L, Linde M (2010) New drugs in migraine treatment and prophylaxis: Telcagepant and topiramate. Lancet 376:645–655. doi:10.1016/S0140-6736(10)60323-6 CrossRefPubMed

12.

Russell FA, King R, Smillie S-J et al (2014) Calcitonin gene-related peptide: physiology and Pathophysiology. Physiol Rev 94:1099–1142. doi:10.1152/physrev.00034.2013 CrossRefPubMedPubMedCentral

13.

Doods H, Hallermayer G, Wu D et al (2000) Pharmacological profile of BIBN4096BS, the first selective small molecule CGRP antagonist. Br J Pharmacol 129:420–423. doi:10.1038/sj.bjp.0703110 CrossRefPubMedPubMedCentral

14.

Vécsei L, Szok D, Csáti A, Tajti J (2015) CGRP antagonists and antibodies for the treatment of migraine. Expert Opin Investig Drugs 24:31–41. doi:10.1517/13543784.2015.960921 CrossRefPubMed

15.

Bigal ME, Walter S, Rapoport AM (2013) Calcitonin gene-related peptide (CGRP) and migraine current understanding and state of development. Headache 53:1230–1244. doi:10.1111/head.12179 CrossRefPubMed

16.

Juhl L, Edvinsson L, Olesen J, Jansen-Olesen I (2007) Effect of two novel CGRP-binding compounds in a closed cranial window rat model. Eur J Pharmacol 567:117–124. doi:10.1016/j.ejphar.2007.04.004 CrossRefPubMed

17.

Edvinsson L, Nilsson E, Jansen-Olesen I (2007) Inhibitory effect of BIBN4096BS, CGRP(8-37), a CGRP antibody and an RNA-Spiegelmer on CGRP induced vasodilatation in the perfused and non-perfused rat middle cerebral artery. BrJPharmacol 150:633–640. doi:10.1038/sj.bjp.0707134

18.

Olesen J, Diener H, Husstedt IW, et al (2004) Calcitonin gene–related peptide receptor antagonist BIBN 4096 BS for the acute treatment of migraine. Society 1104–1110

19.

Connor KM, Aurora SK, Loeys T et al (2011) Long-term tolerability of telcagepant for acute treatment of migraine in a randomized trial. Headache 51:73–84. doi:10.1111/j.1526-4610.2010.01799.x CrossRefPubMed

20.

Connor KM, Shapiro RE, Diener H-C et al (2009) Randomized, controlled trial of telcagepant for the acute treatment of migraine. Neurology 73:970–977CrossRefPubMedPubMedCentral

21.

Diener H-C, Barbanti P, Dahlöf C et al (2011) BI 44370 TA, an oral CGRP antagonist for the treatment of acute migraine attacks: results from a phase II study. Cephalalgia 31:573–584. doi:10.1177/0333102410388435 CrossRefPubMed

22.

Hewitt DJ, Aurora SK, Dodick DW et al (2011) Randomized controlled trial of the CGRP receptor antagonist MK-3207 in the acute treatment of migraine. Cephalalgia 31:712–722. doi:10.1177/0333102411398399 CrossRefPubMed

23.

Hewitt DJ, Martin V, Lipton RB et al (2011) Randomized controlled study of telcagepant plus ibuprofen or acetaminophen in migraine. Headache 51:533–543. doi:10.1111/j.1526-4610.2011.01860.x CrossRefPubMed

24.

Ho AP, Dahlöf CG, Silberstein SD et al (2010) Randomized, controlled trial of telcagepant over four migraine attacks. Cephalalgia 30:1443–1457. doi:10.1177/0333102410370878 CrossRefPubMed

25.

Ho TW, Connor KM, Zhang Y et al (2014) Randomized controlled trial of the CGRP receptor antagonist telcagepant for migraine prevention. Neurology 83:958–966. doi:10.1212/WNL.0000000000000771 CrossRefPubMed

26.

Ho TW, Ferrari MD, Dodick DW et al (2008) Efficacy and tolerability of MK-0974 (telcagepant), a new oral antagonist of calcitonin gene-related peptide receptor, compared with zolmitriptan for acute migraine: a randomised, placebo-controlled, parallel-treatment trial. Lancet 372:2115–2123. doi:10.1016/S0140-6736(08)61626-8 CrossRefPubMed

27.

Ho TW, Ho AP, Chaitman BR et al (2012) Randomized, controlled study of telcagepant in patients with migraine and coronary artery disease. Headache 52:224–235. doi:10.1111/j.1526-4610.2011.02052.x CrossRefPubMed

28.

Ho TW, Ho AP, Ge Y (Joy), et al (2016) Randomized controlled trial of the CGRP receptor antagonist telcagepant for prevention of headache in women with perimenstrual migraine. Cephalalgia 36:148–161. doi: 10.1177/0333102415584308

29.

Ho TW, Mannix LK, Fan X et al (2008) Randomized controlled trial of an oral CGRP receptor antagonist, MK-3207, in the acute treatment of migraine. Neurology 70:1304–1312. doi:10.1177/0333102411398399 CrossRefPubMed

30.

Marcus R, Goadsby PJ, Dodick D et al (2014) BMS-927711 for the acute treatment of migraine: a double-blind, randomized, placebo controlled, dose-ranging trial. Cephalalgia 34:114–125. doi:10.1177/0333102413500727 CrossRefPubMed

31.

Sun H, Dodick DW, Silberstein S et al (2016) Safety and efficacy of AMG 334 for prevention of episodic migraine: a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Neurol 15:382–390. doi:10.1016/S1474-4422(16)00019-3 CrossRefPubMed

32.

Tepper S, Ashina M, Reuter U, et al (2017) Safety and efficacy of erenumab for preventive treatment of chronic migraine: a randomised, double-blind, placebo-controlled phase 2 trial. doi: 10.1016/S1474-4422(17)30083-2

33.

Voss T, Lipton RB, Dodick DW et al (2016) A phase IIb randomized, double-blind, placebo-controlled trial of ubrogepant for the acute treatment of migraine. Cephalalgia 36:887–898. doi:10.1177/0333102416653233 CrossRefPubMed

34.

Dodick DW, Goadsby PJ, Silberstein SD et al (2014) Safety and efficacy of ALD403, an antibody to calcitonin gene-related peptide, for the prevention of frequent episodic migraine: a randomised, double-blind, placebo-controlled, exploratory phase 2 trial. Lancet Neurol 13:1100–1107. doi:10.1016/S1474-4422(14)70209-1 CrossRef

35.

Dodick DW, Goadsby PJ, Spierings ELH et al (2014) Safety and efficacy of LY2951742, a monoclonal antibody to calcitonin gene-related peptide, for the prevention of migraine: a phase 2, randomised, double-blind, placebo-controlled study. Lancet Neurol 13:885–892. doi:10.1016/S1474-4422(14)70128-0 CrossRefPubMed

36.

Bigal ME, Dodick DW, Rapoport AM et al (2015) Safety, tolerability, and efficacy of TEV-48125 for preventive treatment of high-frequency episodic migraine: a multicentre, randomised, double-blind, placebo-controlled, phase 2b study. Lancet Neurol 14:1081–1090. doi:10.1016/S1474-4422(15)00249-5 CrossRefPubMed

37.

Bigal ME, Edvinsson L, Rapoport AM et al (2015) Safety, tolerability, and efficacy of TEV-48125 for preventive treatment of chronic migraine: a multicentre, randomised, double-blind, placebo-controlled, phase 2b study. Lancet Neurol 14:1091–1100. doi:10.1016/S1474-4422(15)00245-8 CrossRefPubMed

38.

D’Amico D, Tepper SJ (2008) Prophylaxis of migraine: General principles and patient acceptance. Neuropsychiatr Dis Treat 4:1155–1167. doi:10.2147/NDT.S3497.CrossRefPubMedPubMedCentral

39.

Silberstein SD, Holland S, Freitag F, et al. (2012) Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults. Neurology 78:1337–45. doi:10.1212/WNL.0b013e3182535d20.CrossRefPubMedPubMedCentral

40.

Lilly’s Galcanezumab Significantly Reduces Number of Migraine Headache Days for Patients with Migraine: New Results Presented at AHS (NYSE:LLY). https://investor.lilly.com/releasedetail.cfm?releaseid=1029791. Accessed 21 Aug 2017

41.

Alder BioPharmaceuticals Announces Positive Eptinezumab Phase 3 Results for Prevention of Frequent Episodic Migraine (NASDAQ:ALDR). http://investor.alderbio.com/releasedetail.cfm?releaseid=1031418. Accessed 21 Aug 2017

42.

Teva’s Fremanezumab Meets all Primary and Secondary Endpoints Across Both Monthly and Quarterly Dosing Regimens in Phase III Study in Episodic Migraine Prevention. http://www.tevapharm.com/news/teva_s_fremanezumab_meets_all_primary_secondary_endpoints_across_both_monthly_and_quarterly_dosing_regimens_in_phase_iii_study_in_episodic_migraine_prevention_06_17.aspx. Accessed 21 Aug 2017

43.

Novartis announces Phase III study shows AMG 334 significantly reduces monthly migraine days in people with episodic migraine | Novartis. https://www.novartis.com/news/media-releases/novartis-announces-phase-iii-study-shows-amg-334-significantly-reduces-monthly. Accessed 21 Aug 2017

44.

Brandes J, Saper J, Diamond M et al (2004) Topiramate for migraine prevention: a randomized controlled trial. JAMA 291:965–973. doi:10.1592/phco.26.3.375 CrossRefPubMed

45.

Diener H-C, Tfelt-Hansen P, Dahlöf C et al (2004) Topiramate in migraine prophylaxis results from a placebo-controlled trial with propranolol as an active control. J Neurol 251:943–950. doi:10.1007/s10072-005-0425-6 CrossRefPubMed

46.

Silberstein SD, Standnes B, Kangasneimi P, et al (2004) Topiramate in migraine prevention. Arch Neurol 61:490–495. doi:10.1001/archneur.61.4.490

47.

Silberstein SD, Lipton RB, Dodick DW et al (2007) Efficacy and safety of topiramate for the treatment of chronic migraine: a randomized, double-blind, placebo-controlled trial. Headache 47:170–180. doi:10.1111/j.1526-4610.2006.00684.x CrossRefPubMed

48.

Diener HC, Bussone G, Van Oene JC et al (2007) Topiramate reduces headache days in chronic migraine: a randomized, double-blind, placebo-controlled study. Cephalalgia 27:814–823. doi:10.1111/j.1468-2982.2007.01326.x CrossRefPubMed

49.

Lilly Announces Positive Results for Three Phase 3 Studies of Galcanezumab for the Prevention of Episodic and Chronic Migraine (NYSE:LLY). https://investor.lilly.com/releasedetail.cfm?releaseid=1026201. Accessed 21 Aug 2017.

50.

Wang W, Wang EQ, Balthasar JP (2008) Monoclonal antibody pharmacokinetics and pharmacodynamics. Clin Pharmacol Ther 84:548–558. doi:10.1038/clpt.2008.170 CrossRefPubMed

51.

Bigal ME, Walter S, Rapoport AM (2015) Therapeutic antibodies against CGRP or its receptor. Br J Clin Pharmacol 79:886–895. doi:10.1111/bcp.12591 CrossRefPubMedPubMedCentral

52.

Iyengar S, Ossipov MH, Johnson KW (2016) The role of CGRP in peripheral and central pain mechanisms including migraine. Pain 158:543–559. doi:10.1097/j.pain.0000000000000831 CrossRef

53.

Sur C, Hargreaves RJ, Bell IM et al (2009) CSF levels and binding pattern of novel CGRP receptor antagonists in rhesus monkey and human central nervous system: toward the development of a PET tracer. Cephalalgia 29:136–137

54.

Uddman R, Edvinsson L, Ekblad E et al (1986) Calcitonin gene-related peptide (CGRP): perivascular distribution and vasodilatory effects. Regul Pept 15:1–23. doi:10.1016/0167-0115(86)90071-6

55.

Wimalawansa J, MacIntyre I (1988) Calcitonin gene-related peptide and its specific binding sites in the cardiovascular system of rat. Int J Cardiol 20:29–37

56.

Opgaard OS, Gulbenkian S, Bergdahl A et al (1995) Innervation of human epicardial coronary veins: immunohistochemistry and vasomotility. Cardiovasc Res 29:463–468CrossRef

57.

Lindstedt IH, Edvinsson M-L, Edvinsson L (2006) Reduced responsiveness of cutaneous microcirculation in essential hypertension--a pilot study. Blood Press 15:275–280. doi:10.1080/08037050600996586 CrossRefPubMed

58.

McCulloch J, Uddman R, Kingman TA, Edvinsson L (1986) Calcitonin gene-related peptide: functional role in cerebrovascular regulation. Proc Natl Acad Sci U S A 83:5731–5735. doi:10.1073/pnas.83.15.5731 CrossRefPubMedPubMedCentral

59.

Edvinsson L, Uddman R, Mulder H (1998) Calcitonin gene-related peptide and nitric oxide in the trigeminal ganglion: cerebral vasodilation from trigeminal nerve stimulation involves mainly calcitonin gene-related peptide. J Aut Nerv Syst 70:15–22CrossRef

60.

Keith IM, Tjen AL, Kraiczi H, Ekman R (2000) Three-week neonatal hypoxia reduces blood CGRP and causes persistent pulmonary hypertension in rats. AmJPhysiolHeart CircPhysiol 279:H1571–H1578

61.

Sacco S, Kurth T (2014) Migraine and the risk for stroke and cardiovascular disease. Curr Cardiol Rep 16:1–7. doi:10.1007/s11886-014-0524-1 CrossRef

62.

Kurth T, Winter AC, Eliassen AH et al (2016) Migraine and risk of cardiovascular disease in women: prospective cohort study. BMJ 253:i2610. doi:10.1136/bmj.i2610 CrossRef

63.

Salmona M, Damaj Mi, Marubio Lm, et al (2001) Altered neuroadaptation in opiate dependence and neurogenic inflammatory nociception in alpha CGRP-deficient mice. Nat Neurosci 4:357–358. doi: 10.1100/tsw.2001.439

64.

Zhang L, Hoff AO, Wimalawansa SJ et al (2001) Arthritic calcitonin/α calcitonin gene-related peptide knockout mice have reduced nociceptive hypersensitivity. Pain 89:265–273. doi:10.1016/S0304-3959(00)00378-X CrossRefPubMed

65.

Benschop RJ, Collins EC, Darling RJ et al (2014) Development of a novel antibody to calcitonin gene-related peptide for the treatment of osteoarthritis-related pain. Osteoarthr Cartil 22:578–585. doi:10.1016/j.joca.2014.01.009 CrossRefPubMed

66.

Khalil Z, Helme R (1996) Sensory peptides as Neuromodulators of wound healing in aged rats. J Gerontol Ser A Biol Sci Med Sci 51A:B354–B361. doi:10.1093/gerona/51A.5.B354 CrossRef

67.

Roggenkamp D, Köpnick S, Stäb F et al (2013) Epidermal nerve fibers modulate Keratinocyte growth via Neuropeptide signaling in an innervated skin model. J Invest Dermatol 133:1620–1628. doi:10.1038/jid.2012.464 CrossRefPubMed

68.

Mishima T, Ito Y, Hosono K et al (2011) Calcitonin gene-related peptide facilitates revascularization during hindlimb ischemia in mice. Am J Physiol Circ Physiol 300:H431–H439. doi:10.1152/ajpheart.00466.2010 CrossRef

69.

Zhang X, Zhuang J, Wu H et al (2010) Inhibitory effects of Calcitonin gene-related peptides on experimental vein graft disease. Ann Thorac Surg 90:117–123. doi:10.1016/j.athoracsur.2010.03.063 CrossRefPubMed

70.

Mulderry PK, M A G, R a S et al (1988) Differential expression of alpha-CGRP and beta-CGRP by primary sensory neurons and enteric autonomic neurons of the rat. Neuroscience 25:195–205. doi:10.1016/0306-4522(88)90018-8 CrossRefPubMed

71.

STERNINI C (1992) Enteric and visceral afferent CGRP neurons: targets of Innervation and differential expression patterns. Ann N Y Acad Sci 657:170–186. doi: 10.1111/j.1749-6632.1992.tb22766.x

72.

Peskar BM, Wong HC, Walsh JH, Holzer P (1993) A monoclonal antibody to calcitonin gene-related peptide abolishes capsaicin-induced gastroprotection. Eur J Pharmacol 250:201–203. doi:10.1016/0014-2999(93)90645-X CrossRefPubMed

73.

Reinshagen M, Flämig G, Ernst S et al (1998) Calcitonin gene-related peptide mediates the protective effect of sensory nerves in a model of colonic injury. J Pharmacol Exp Ther 286:657–661PubMed

74.

Bartho L, Koczan G, Maggi CA (1993) Studies on the mechanism of the contractile action of rat calcitonin gene-related peptide and of capsaicin on the guinea-pig lleum: effect of hCGRP (8-37) and CGRP tachyphylaxis. Neuropeptides 25:325–329. doi:10.1016/0143-4179(93)90051-B CrossRefPubMed

75.

Ohno T, Hattori Y, Komine R et al (2008) Roles of Calcitonin gene-related peptide in maintenance of gastric mucosal integrity and in enhancement of ulcer healing and angiogenesis. Gastroenterology 134:215–225. doi:10.1053/j.gastro.2007.10.001 CrossRefPubMed

76.

Schankin CJ, Maniyar FH, Seo Y et al (2016) Ictal lack of binding to brain parenchyma suggests integrity of the blood-brain barrier for 11C-dihydroergotamine during glyceryl trinitrate-induced migraine. Brain 139:1994–2001. doi:10.1093/brain/aww096 CrossRefPubMedPubMedCentral

77.

Hougaard A, Amin FM, Christensen CE et al (2017) Increased brainstem perfusion, but no blood-brain barrier disruption, during attacks of migraine with aura. Brain 140:1–10. doi:10.1093/brain/awx089 CrossRef

78.

Eftekhari S, Salvatore CA, Johansson S et al (2015) Localization of CGRP, CGRP receptor, PACAP and glutamate in trigeminal ganglion. Relation to the blood-brain barrier. Brain Res 1600:93–109. doi:10.1016/j.brainres.2014.11.031 CrossRefPubMed

79.

Wimalawansa SJ, El-Kholy AA (1993) Comparitive study of distribution and biochemical characterization of brain calcitonin gene-related peptide receptors in five different species. Neuroscience 54:513–519CrossRefPubMed

80.

Mitsikostas DD, Reuter U (2017) Calcitonin gene-related peptide monoclonal antibodies for migraine prevention : comparisons across randomized controlled studies. Curr Opin Neurol 30:272–280. doi:10.1097/WCO.0000000000000438 CrossRefPubMed

81.

Hepp Z, Dodick DW, Varon SF et al (2015) Adherence to oral migraine-preventive medications among patients with chronic migraine. Cephalalgia 35:478–488. doi:10.1177/0333102414547138 CrossRefPubMed

82.

Hepp Z, Bloudek LM, Varon SF (2014) Systematic review of migraine prophylaxis adherence and persistence. J Manag Care Pharm 20:22–33PubMed

83.

Zhou H, Mascelli MA (2011) Mechanisms of monoclonal antibody–drug interactions. Annu Rev Pharmacol Toxicol 51:359–372. doi:10.1146/annurev-pharmtox-010510-100510 CrossRefPubMed

84.

Gangula PRR, Wimalawansa SJ, Yallampalli C (2002) Sex steroid hormones enhance Hypotensive effects of Calcitonin gene-related peptide in aged female rats. Biol Reprod 67:1881–1887. doi:10.1095/biolreprod.102.007682 CrossRefPubMed

85.

Walker CS, Eftekhari S, Bower RL et al (2015) A second trigeminal CGRP receptor: function and expression of the AMY1 receptor. Ann Clin Transl Neurol 2:595–608. doi:10.1002/acn3.197 CrossRefPubMedPubMedCentral

86.

Haanes KA, Chan KY, MaassenVanDenBrink A (2016) Comment on “a second trigeminal CGRP receptor: function and expression of the AMY1 receptor.”. Ann Clin Transl Neurol 3:307–308. doi:10.1002/acn3.286 CrossRefPubMedPubMedCentral

87.

Estemalik E, Tepper S (2013) Preventive treatment in migraine and the new US guidelines. Neuropsychiatr Dis Treat 9:709–720. doi:10.2147/NDT.S33769 CrossRefPubMedPubMedCentral

Title: Blocking CGRP in migraine patients – a review of pros and cons
Authors: Marie Deen
Edvige Correnti
Katharina Kamm
Tim Kelderman
Laura Papetti
Eloisa Rubio-Beltrán
Simone Vigneri
Lars Edvinsson
Antoinette Maassen Van Den Brink
On behalf of the European Headache Federation School of Advanced Studies (EHF-SAS)
Publication date: 01-12-2017
Publisher: Springer Milan
Published in: The Journal of Headache and Pain / Issue 1/2017
Print ISSN: 1129-2369
Electronic ISSN: 1129-2377
DOI: https://doi.org/10.1186/s10194-017-0807-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Blocking CGRP in migraine patients – a review of pros and cons

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2017

The role of the transient receptor potential ankyrin type-1 (TRPA1) channel in migraine pain: evaluation in an animal model

Lower inhibitory control interacts with greater pain catastrophizing to predict greater pain intensity in women with migraine and overweight/obesity

Post-traumatic headache in patients with minimal traumatic intracranial hemorrhage after traumatic brain injury: a retrospective matched case-control study

Clinical patterns of primary stabbing headache: a single clinic-based prospective study

Mindfulness and pharmacological prophylaxis after withdrawal from medication overuse in patients with Chronic Migraine: an effectiveness trial with a one-year follow-up

Functional connectivity and cognitive impairment in migraine with and without aura