CGRP and Immune Modulation: Evidence-Based Therapy

Since the discovery of calcitonin gene-related peptide (CGRP), numerous studies have investigated its role in migraine pathogenesis. CGRP, the most common neuropeptide in the trigeminal system, causes vasodilation, upregulates nociception, and modulates regional immune mediators leading to neurogenic neuroinflammation and pain sensitization. Many clinical studies have demonstrated the superior efficacy of CGRP functional blocking monoclonal antibodies (MAbs) in migraine prevention. These findings have prompted the approval of four different preparations, with three targeting at CGRP ligands and one targeting at CGRP receptors. They appear as effective and more tolerable than conventional migraine preventives. CGRP functional blocking MAbs thus are promising new additions for the treatment of migraine.