Migraine attacks aren’t just headaches — they’re complicated neurological conditions that can significantly affect daily life. For people who get frequent or chronic migraine headaches, finding effective treatment can feel like a never-ending challenge.

New treatments have brought hope with a type of medicine called anti-calcitonin gene-related peptide (anti-CGRP) medications. These drugs aim to prevent or reduce the number and severity of migraine attacks, providing relief for people who haven’t found success with other treatments.

What Is Calcitonin Gene-Related Peptide?

CGRP is a protein in the brain and nervous system that helps transmit pain signals and dilate (widen) blood vessels. During a migraine attack, levels of CGRP rise, leading to pain and other migraine symptoms. The connection between CGRP and migraine was discovered through extensive research, opening the door to a new approach to migraine treatment.

Anti-CGRP medications, also called CGRP receptor antagonists, work by targeting and blocking the effects of calcitonin gene-related peptide. These medications can keep migraine attacks from starting or reduce how long they last or severe they get. The U.S. Food and Drug Administration (FDA) has approved this class of drugs for preventing or treating migraine attacks.

With the recent approvals of “gepants” — medications with names ending in “-gepant,” — and other anti-CGRP drugs, it’s no surprise that many people are curious about this drug class. One MyMigraineTeam member asked, “Has anyone used Ubrelvy or Nurtec? What are the differences?” Another said, “I’m on Qulipta, but I was just prescribed Nurtec. Which is better?”

This article will review some of the most popular medications in the class and how they differ.

Current Anti-CGRP Medications for Migraine

Several anti-CGRP medications have been developed and approved for use in treating or preventing migraine attacks. Each works slightly differently, but they all share the goal of disrupting the role of CGRP in migraine attacks. Here’s a closer look at some of the most popular options.

Atogepant

Atogepant (Qulipta) is a newer oral medication for preventing migraine attacks. Unlike some other anti-CGRP treatments, atogepant is taken by mouth, making it a convenient option for many people. Atogepant works by blocking the CGRP receptor, which prevents the protein from triggering the migraine process.

Clinical trials have shown that atogepant can significantly reduce the frequency of migraine days per month. In a 2022 study, participants taking atogepant had a reduction of about four migraine days per month compared to about three days for participants receiving a placebo (sham treatment).

Eptinezumab-Jjmr

Eptinezumab-jjmr (Vyepti) is injected intravenously (into a vein) once every three months. This drug targets CGRP by binding to it so that it can’t attach to its receptors in the brain. This medication has been effective in lowering the number of migraine days in people who get frequent attacks.

In clinical trials, eptinezumab greatly reduced how often people with chronic migraine had attacks, with some seeing their monthly migraine days cut by more than half.

Erenumab-Aooe

Erenumab-aooe (Aimovig) is the first anti-CGRP medication approved by the FDA specifically for the prevention of migraine attacks. Unlike other treatments that bind directly to the CGRP molecule, this drug blocks the CGRP receptor, preventing the molecule from attaching and triggering a migraine attack. Erenumab-aooe is given as a monthly self-injection under the skin. Clinical trials showed that erenumab reduced the number of migraine days a month by about 6.6 days, compared to 4.2 days with placebo.

Fremanezumab-Vfrm

Fremanezumab-vfrm (Ajovy) is also used to prevent migraine attacks and is injected under the skin. People can choose to receive this medication either monthly or every three months, depending on their preference and treatment plan. Fremanezumab binds to CGRP, similar to how eptinezumab-jjmr works.

Studies have shown that fremanezumab can reduce the frequency of migraine attacks, even in people who haven’t responded well to other treatments. One study found that participants receiving fremanezumab had an average reduction of four migraine days per month compared to two days for those receiving a placebo.

Galcanezumab-Gnlm

Galcanezumab-gnlm (Emgality) is an injection given under the skin once a month. It works by blocking the effects of CGRP, similar to other medications in this class. Galcanezumab has been particularly effective for those experiencing acute (immediate) and chronic (recurring) migraine.

In clinical trials, galcanezumab has been shown to reduce the number of migraine days per month by about 4.5 days in some with migraine, and it’s also been linked with improvements in overall quality of life.

Rimegepant

Rimegepant (Nurtec ODT) is unique among anti-CGRP medications — it’s used as both a preventive and an acute treatment. Taken as an orally disintegrating tablet (ODT), it dissolves on or under the tongue without water and works quickly to block CGRP receptors, similar to other medications in this class.

In clinical trials, rimegepant was shown to reduce migraine headache frequency as a preventive treatment and relieve pain and other symptoms when taken during a migraine attack. This dual action offers flexibility for those who need both types of treatment in one medication.

Ubrogepant

Ubrogepant (Ubrelvy) is specifically designed for the acute treatment of migraine attacks. Taken as a tablet, ubrogepant works by blocking CGRP receptors and is used to stop migraine attacks that have already started, rather than preventing them.

What makes ubrogepant stand out is that it helps relieve migraine symptoms without causing drowsiness like some other migraine treatments, such as triptans. In clinical trials, many participants felt significantly better within two hours of taking this drug.

Ubrogepant provides an option for those who prefer an oral treatment that offers rapid relief from migraine pain and symptoms without the use of injections or nasal sprays.

Zavegepant

Zavegepant (Zavzpret), a newer option in the anti-CGRP class, is unique because it’s given as a nasal spray. This type of formula can benefit people who need immediate symptom relief. Zavegepant is used to treat rather than prevent acute migraine attacks.

In clinical trials, nasal sprays have been shown to relieve migraine symptoms within 15 minutes of use, offering a rapid solution to those who experience sudden and severe migraine attacks.

Common Side Effects and Considerations

Although anti-CGRP medications have proved effective for many people, they’re not without potential side effects. Common side effects include:

• Injection site reactions (for injectable forms)
• Constipation
• Allergic reactions

The nasal spray, zavegepant, can also cause nasal discomfort or irritation. Most side effects are mild to moderate, but it’s important to discuss these risks with your health care provider.

The medications’ cost and insurance coverage should also be considered. Since anti-CGRP treatments are relatively new among migraine medications, they can be expensive, and some insurance plans may require prior authorization (approval). Many drug companies offer assistance programs to help offset the cost for people who qualify. Your health care provider and insurance company can help you navigate these issues.

Who Can Benefit From Anti-CGRP Medications?

Anti-CGRP medications are generally prescribed for people with chronic migraine, which by definition means having 15 or more headache days a month, of which at least eight are migraine headaches. These drugs may also be helpful for people who haven’t responded well to other treatments or who develop severe side effects from other medications.

In addition, these medications may be an option for people who experience migraine symptoms less often, particularly if migraine attacks are severe or disabling. Your health care provider can determine the best course of treatment for you.

Accessing Anti-CGRP Treatments

If you think anti-CGRP medications might help you, the first step is to talk with your health care provider. They can review your migraine patterns and see if these treatments might be right for you. Your doctor and pharmacist can also help you figure out the insurance process, which can be tricky. Before approving anti-CGRP medications, some health plans may require that you first try other treatments with no success, a process known as step therapy. Staying persistent and keeping in touch with your health care provider can help you get the treatment you need.

Migraine can be a life-changing condition, but you don’t have to face it alone. Anti-CGRP medications offer new hope for managing migraine. If you or a loved one is living with migraine, discuss these options — and their risks and benefits — with your health care provider. Together, you can develop a plan that works for you.

Talk With Others Who Understand

MyMigraineTeam is the social network for people with migraine and their loved ones. On MyMigraineTeam, more than 83,000 members come together to ask questions, give advice, and share their stories with others who understand life with migraine.

Have you tried anti-CGRPs for migraine? What has your experience been like? Share your experience in the comments below, or start a conversation by posting on your Activities page.