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Review
. 2025 Apr;48(2):40-46.
doi: 10.18773/austprescr.2025.017.

Calcitonin gene-related peptide-targeted therapies for migraine

Stephanie Barnes  1   2   3   4   5   6   7 , Lucie Aldous  1   2   3   4   5   6   7 , Bronwyn Jenkins  1   2   3   4   5   6   7
Affiliations
Review

Calcitonin gene-related peptide-targeted therapies for migraine

Stephanie Barnes et al. Aust Prescr. 2025 Apr.

Abstract

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.

Keywords: CGRP receptor antagonists; calcitonin gene-related peptide; gepants; migraine; monoclonal antibodies.

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Conflict of interest statement

Conflicts of interest: Stephanie Barnes received partial support from AbbVie for a clinical fellowship position from 2019 to 2020. She is a current committee member of the Australian and New Zealand Headache Society. Lucie Aldous is a member of the expert group for Therapeutic Guidelines: Neurology version 6 (under review). Lucie received consultancy fees from Teva (fremanezumab) in 2019 and provided expert review for the Bellberry Human Research Ethics Committee for the MOMENT pilot study in 2024. She is a current committee member of the Australian and New Zealand Headache Society. Bronwyn Jenkins received fees for being on advisory boards for Novartis (erenumab), Teva (fremanezumab), Lilly (galcanezumab), AbbVie (onabotulinum toxin A) and Pfizer (rimegepant). Bronwyn previously received honoraria from Care Pharmacy, Healthed, and General Practice Conference and Exhibition for invited lectures. Bronwyn is on development and leadership, ethics, and education subcommittees of the International Headache Society (IHS) and is leading the development of educational materials for general practitioners. Bronwyn is an Associate Editor for Cephalalgia. She is the immediate-past president of the Australian and New Zealand Headache Society, previous board member of the IHS and an author of the 2024 IHS Global Practice Recommendations for the Acute and Preventive Pharmacological Treatment of Migraine.

Figures

Figure 1
Figure 1
The role of calcitonin gene-related peptide (CGRP) in migraine pathophysiology and possible sites of action of CGRP-targeted therapies in migraine
See this image and copyright information in PMC

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