Update of Gepants in the Treatment of Chronic Migraine

Curr Pain Headache Rep. 2023 Oct;27(10):561-569. doi: 10.1007/s11916-023-01167-6. Epub 2023 Sep 1.

Abstract

Purpose of review: Despite the unmet therapeutic needs of patients with chronic migraine (CM) and/or medication overuse, available treatment options are limited. Recently, four calcitonin gene-related peptide receptor antagonists, known as gepants, have been approved for the treatment of migraine. This review focuses on the preventive treatment of CM with gepants and highlights recent findings.

Recent findings: Two randomized controlled trials (RCTs) have shown promising results for rimegepant and atogepant as preventive treatments for CM. In an RCT targeting patients with CM, atogepant demonstrated a significant reduction in the mean monthly migraine days, irrespective of acute medication overuse. Moreover, the patients reported no significant safety concerns and exhibited good tolerance to treatment. These findings highlight the potential of gepants as a new and effective therapeutic option for patients with CM and/or medication overuse. Gepant use will help improve the management and quality of life of individuals with this debilitating condition.

Keywords: Atogepant; Calcitonin gene-related peptide (CGRP) receptor antagonist; Chronic migraine; Gepants; Medication overuse; Rimegepant.

Publication types

  • Review

MeSH terms

  • Calcitonin Gene-Related Peptide
  • Calcitonin Gene-Related Peptide Receptor Antagonists / therapeutic use
  • Humans
  • Migraine Disorders* / chemically induced
  • Migraine Disorders* / drug therapy
  • Piperidines*
  • Prescription Drug Overuse*
  • Pyridines*
  • Pyrroles*
  • Spiro Compounds*

Substances

  • Calcitonin Gene-Related Peptide Receptor Antagonists
  • atogepant
  • Calcitonin Gene-Related Peptide
  • Piperidines
  • Pyridines
  • Pyrroles
  • Spiro Compounds