CGRP Therapies as Potential First-Line Migraine Preventive Treatment: Andrew Charles, MD

WATCH TIME: 5 minutes

"These are the first preventive therapies that have been developed specifically for migraine based on a really solid foundation of science."

In April 2024, the American Headache Society (AHS) updated its position statement on calcitonin gene-related peptide (CGRP)-targeting therapies for migraine prevention.¹ Unlike previous first-line therapies, which were initially developed for other conditions, CGRP-targeting treatments were specifically designed based on a solid foundation of evidence demonstrating CGRP’s crucial role in migraine pathogenesis. These therapies, including monoclonal antibodies, have shown to significantly improve migraine management, but they are still not universally considered as first-line options.¹

Published in Headache, a review of extensive clinical trial data, post hoc analyses, and real-world experience indicated that CGRP-targeting therapies outperform previous preventive treatments in terms of efficacy, tolerability, and safety.² The studies suggested that these therapies are as effective, if not more so, than traditional first-line options, with serious adverse events being rare. As a result, the AHS recommended considering CGRP-targeting therapies as a first-line preventive treatment for migraine, without requiring prior failure of other treatments.

At the 2025 American Academy of Neurology (AAN) Annual Meeting, held April 5-9, in San Diego, California, Andrew Charles, MD, director of the UCLA Goldberg Migraine Program, presented a talk on why CGRP antagonists should be first-line migraine treatments.³ Following the session, he spoke with NeurologyLive^® about the differences between acute and preventive treatments, emphasizing the superior efficacy, tolerability, and safety of CGRP therapies compared with traditional options. He also noted growing payer support for these therapies as first-line options, backed by strong clinical trial and real-world data.

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REFERENCES
1. American Headache Society publishes updated guidance on migraine preventive therapy. American Headache Society. March 11, 2024. Accessed April 6, 2025. https://www.prnewswire.com/news-releases/american-headache-society-publishes-updated-guidance-on-migraine-preventive-therapy-302085761.html
2. Charles AC, Digre KB, Goadsby PJ, Robbins MS, Hershey A. Calcitonin gene-related peptide-targeting therapies are a first-line option for the prevention of migraine: an American Headache Society position statement update. Headache. Published March 11, 2024. doi:10.1111/head.14692
3. Charles A. Yes: Should CGRP Antagonists Be First Line for Migraine Treatment?. Presented at: 2025 AAN Annual Meeting; April 5-9; San Diego, CA. Controversies in Neurology Plenary Session.

Editor’s Note: Charles has disclosed that he has received personal compensation for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer, Lundbeck, Abbvie, Amgen, and Vectura. The institution of Charles has received research support from NIH. He also noted that he has received publishing royalties from a publication relating to health care and has a noncompensated relationship as an Executive Board Member with American Headache Society that is relevant to AAN interests or activities.