What Are These New Medications?
CGRP monoclonal antibodies (often called CGRP mAbs) are a newer class of migraine prevention medications that work differently from traditional options. These include drugs like erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), eptinezumab (Vyepti). There are also two oral preventive CGRP drugs, rimegepant (Nurtec) and atogepant (Qulipta). Unlike older preventive medications that were originally designed for other conditions, these drugs specifically target the biological pathways involved in migraine.
The Numbers Are Surprising
Researchers analyzed data from nearly 40,000 Americans with migraine and found some eye-opening statistics:
Only about 1 in 4 people with migraine had ever tried any preventive medication
Just 5% had ever used the newer CGRP medications
Among those who did try CGRP mAbs, less than half (46%) continued using their original medication
Who’s More Likely to Use These Medications?
The study found that people most likely to use CGRP mAbs were those who:
Were already using recommended acute migraine medications
Had medical conditions that prevented them from using triptans (common acute migraine medications)
Had access to specialist care, indicated by use of treatments like botulinum toxin injections
The Botulinum Toxin Connection: A Key Finding
One of the most significant discoveries in this study was the strong association between CGRP medications and botulinum toxin (Botox) treatments1. The researchers found that people currently using botulinum toxin for chronic migraine were much more likely to continue their CGRP medication successfully.
Why This Matters:
People using both treatments together were over 4 times more likely to continue their CGRP medication compared to those who stopped treatment entirely
They were also more than twice as likely to stick with their original CGRP medication rather than switching to a different one
This suggests these two treatments may work particularly well together, providing enhanced benefits when used in combination
The connection makes clinical sense: botulinum toxin is typically reserved for people with chronic migraine (15 or more headache days per month) and is usually administered by specialists. This indicates that people receiving this combination therapy likely have more severe migraine and access to specialized care.
Why People Started Treatment
The top reasons people began using CGRP mAbs included:
Belief that the medication would be effective (61%)
Convenient dosing (monthly or quarterly injections) (48%)
Doctor or family/friend recommendations (43%)
Why Some People Switched or Stopped
Among those who switched to a different CGRP medication, cost and insurance issues were the biggest factors (59%). For those who stopped treatment entirely, the reasons were more varied, including cost concerns (36%), side effects (32%), and lack of effectiveness (28%).
What This Means for Migraine Sufferers
Despite being recommended as first-line treatments by headache specialists, these newer medications remain underused. This suggests several potential barriers:
Access issues: Insurance requirements and costs may limit availability
Awareness gaps: Many people with migraine may not know about these options
Healthcare disparities: Not everyone has access to specialists who commonly prescribe these medications
The strong association with botulinum toxin use suggests that combination therapy may be particularly effective for people with chronic migraine, and that specialized care can significantly improve treatment outcomes.
The Bottom Line
While CGRP monoclonal antibodies represent a significant advancement in migraine prevention, many people who could benefit from them aren’t receiving these treatments1. The research shows that when used in combination with botulinum toxin, these medications are much more likely to be continued successfully, suggesting enhanced benefits from this combination approach.
If you have frequent migraines that impact your daily life, especially chronic migraine, it may be worth discussing these newer options with your healthcare provider or a headache specialist. The combination of CGRP medications and botulinum toxin may be particularly beneficial for those with chronic migraine who haven’t found relief with traditional treatments.
The research highlights the importance of improving access to these medications and ensuring that people with migraine are aware of all their treatment options, including combination therapies that may provide superior outcomes for managing this often debilitating condition.
