The American Headache Society (AHS) recently published a consensus position statement with guidance supporting the use of calcitonin gene-related peptide (CGRP)-targeting therapies. The new guidance encourages clinicians to consider CGRP-targeting therapies as a first-line approach for migraine prevention along with previous first-line treatments, without a requirement for prior failure of other classes of migraine preventive treatment.

The consensus paper was published in Headache: The Journal of Head and Face Pain. The AHS Board of Directors completed a comprehensive review of evidence from more than a decade of clinical trials and real-world experiences since 2018 which showed that CGRP-targeting therapies are effective, well tolerated, and safe over the long-term. Research supported both small-molecule CGRP receptor antagonists (rimegepant and atogepant) as well as monoclonal antibodies (erenumab, fremanezumab, galcanezumab, and eptinezumab).

Providing Effective Prevention As Soon As Possible

Moving CGRP-targeting therapies to a first-line treatment option  could help people receive the most appropriate treatment as soon as possible. According to the paper, approximately 40% of patients with migraine could benefit from preventive therapy, yet only a minority of patients are using such treatments.  Moving up CGRP-targeted therapies to a first line option allows a level field for the patient and treating clinician to make the most patient-centric choice, and hopefully allow the greatest chance for success without having to first jump through other treatments that might not be the most optimal for that individual.

“Through its extensive review of both controlled trials and in real-world experience, the American Headache Society has shown that these medications are safe, efficient and well-tolerated,” said American Migraine Foundation’s Chair Christine Lay, MD, FAHS. “The recommendation to provide CGRP-targeting therapies as a first line of treatment will bring these medications to people with migraine much more quickly and provide more targeted prevention for the many people who have not been able to find relief with previous options.”

Along these lines, there have been multiple studies that have shown that CGRP-targeting therapies can work for people for whom other therapies have not worked. 

Although CGRP-targeting preventive therapies are significantly more expensive on a yearly basis, this new manuscript from AHS recommends that cost considerations should not be based solely on the cost of treatment. The recommendation is that other factors such as reductions in cost due to healthcare utilization and acute therapies as well as improvements in other socioeconomic factors such as productivity, absenteeism, and other relationships, must also be considered.