DR. SAI SINDHURI MARUVADA,DR. SORNAVALLI. V,DR. PALLAMPARTHY GAUTHAM
DOI: https://doi.org/Background: Migraine is a chronic neurological disorder characterized by recurrent headaches and associated symptoms that significantly impact quality of life. Recent advancements have identified the calcitonin gene-related peptide (CGRP) pathway as a key contributor in migraine pathophysiology. CGRP receptor antagonists, also known as gepants, and monoclonal antibodies targeting CGRP or its receptor, have emerged as promising agents for migraine prophylaxis.
Objective: To systematically review current literature evaluating the efficacy, safety, and tolerability of CGRP antagonists in the prevention of migraine in adults.
Methods: A systematic search was conducted using PubMed, Scopus, and Cochrane Library for clinical trials and observational studies published between January 2010 and June 2025. Inclusion criteria encompassed randomized controlled trials (RCTs), cohort studies, and real-world studies assessing CGRP antagonists for migraine prophylaxis in adults. Data on study design, patient demographics, intervention, outcome measures, and adverse effects were extracted and analyzed qualitatively.
Results: A total of 18 studies met the inclusion criteria, comprising 13 RCTs and 5 observational studies. CGRP monoclonal antibodies including erenumab, fremanezumab, galcanezumab, and eptinezumab consistently demonstrated a significant reduction in monthly migraine days (MMDs) compared to placebo, with mean reductions ranging between 3 to 5 MMDs. Gepants such as atogepant and rimegepant also showed moderate preventive efficacy, especially in episodic migraine. Treatment-emergent adverse events were generally mild to moderate, with constipation and injection site reactions being most common.
Conclusion: CGRP antagonists, both monoclonal antibodies and oral gepants, are effective and well-tolerated options for migraine prevention in adults. Their targeted mechanism offers advantages over traditional therapies. Long-term data and head-to-head trials are needed to determine optimal treatment strategies and comparative efficacy.
