An Overview of New Biologics for Migraine Prophylaxis

Philip Harvey, PharmD/MBA Candidate 2020; Pooja Shah, PharmD/MBA Candidate 2020; Scott Shipley, PharmD, BCPS


US Pharmacist. 2020;45(1):21-24. 

In This Article

Mechanism of Action

Traditional first-line therapy for migraine includes several medications from multiple drug classes and lacks a definitive treatment algorithm. Patients often present to a physician after unsuccessfully attempting multiple nonprescription therapies.[1] Migraine patients have increased levels of CGRP, which has been shown to play an important role in the pathophysiology of migraine.[5] This neuropeptide, when bound to its receptor, is responsible for a cascade of events that contribute to neurogenic inflammation, including mast-cell degranulation, vasodilation, and protein extravasation. CGRP antagonists are humanized monoclonal antibodies that bind to the CGRP receptor or ligand and block its binding activity selectively; this is believed to block the aforementioned cascade of events, thus preventing migraine.[5] This is the first class of medications designed for the prevention of migraines to work with this mechanism.