Do Anti-CGRP mAbs Work For Aura In Migraine With Aura Patients?

Do Anti-CGRP mAbs Work For Aura In Migraine With Aura Patients?

Current evidence suggests that anti-CGRP monoclonal antibodies are unable to directly affect migraine aura frequency or severity due to their inability to penetrate the blood-brain barrier. However, they may reduce headache incidence following aura attacks. Further randomized controlled trials are needed to elucidate the effects of anti-CGRP antibodies on aura frequency and severity.

Source: https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-023-01637-7

I'm going to cut this short with only the summary above because, as I write this, a new study was just published TODAY (August 9th, 2023) disagreeing with the aforementioned. Science moves fast. In the study, it was found that greater reductions in centrally-mediated migraine symptoms like photophobia, phonophobia, and aura were observed compared to headache day reduction.

Yes, you read that correctly. In patients who responded to anti-CGRP mAbs (greater than or equal to 50% response), the number of photophobia, phonophobia, and aura days were LESS than the number of headache days. 

As we stated above, anti-CGRP mAbs are large molecules that do not cross the blood-brain barrier.

So how is this possible since molecularly it doesn’t make sense?

Well, there are a few possibilities. Modulating CGRP signaling in the periphery may affect pain signaling to the central trigeminal nuclei and connected brain regions. This then may disrupt the activation of central migraine pathways. Essentially, this suggests the peripheral action of the antibodies may indirectly affect central migraine mechanisms.

It’s also possible that CGRP may play a direct role in regulating migraine symptoms like photophobia, phonophobia, and aura. So, if photophobia and phonophobia are partially peripherally regulated by CGRP, anti-CGRP mAbs may improve these specific symptoms more than headache frequency.

Source: https://journals.sagepub.com/doi/10.1177/03331024231177636

Back to blog
  • Migraine Attacks Independent of CGRP (cGMP-mediated migraine)

    Migraine Attacks Independent of CGRP (cGMP-medi...

    Cerebral Torque

    A randomized, double-blind, placebo-controlled study published in Cephalalgia investigated whether sildenafil (Viagra), a phosphodiesterase-5 (PDE-5) inhibitor that increases cGMP levels, could induce migraine attacks in individuals with migraine who were pre-treated with...

    Migraine Attacks Independent of CGRP (cGMP-medi...

    Cerebral Torque

    A randomized, double-blind, placebo-controlled study published in Cephalalgia investigated whether sildenafil (Viagra), a phosphodiesterase-5 (PDE-5) inhibitor that increases cGMP levels, could induce migraine attacks in individuals with migraine who were pre-treated with...

  • Migraine Aura vs TIA

    Migraine Aura vs TIA

    Cerebral Torque

    It can sometimes be difficult to distinguish between migraine aura and TIA, especially in cases of hemiplegic migraine, migraine with brainstem aura, or retinal migraine. Pay close attention to the...

    Migraine Aura vs TIA

    Cerebral Torque

    It can sometimes be difficult to distinguish between migraine aura and TIA, especially in cases of hemiplegic migraine, migraine with brainstem aura, or retinal migraine. Pay close attention to the...

  • The Migraine Brain Does NOT Like Routine: Do you want to win the battle or the war?

    The Migraine Brain Does NOT Like Routine: Do yo...

    Cerebral Torque

    Many in the migraine community have heard the common phrase "the migraine brain loves routine." However, a recent study suggests that this advice, while potentially helpful in the short-term, may...

    The Migraine Brain Does NOT Like Routine: Do yo...

    Cerebral Torque

    Many in the migraine community have heard the common phrase "the migraine brain loves routine." However, a recent study suggests that this advice, while potentially helpful in the short-term, may...

  • Cardiovascular Safety of Anti-CGRP Monoclonal Antibodies in Migraine Treatment

    Cardiovascular Safety of Anti-CGRP Monoclonal A...

    Cerebral Torque

    The researchers discovered that 3.1% of participants experienced abnormal ECGs or cardiovascular adverse events. Among these, 1.6% encountered more severe complications, such as cerebellar stroke, spontaneous coronary artery dissection, or...

    Cardiovascular Safety of Anti-CGRP Monoclonal A...

    Cerebral Torque

    The researchers discovered that 3.1% of participants experienced abnormal ECGs or cardiovascular adverse events. Among these, 1.6% encountered more severe complications, such as cerebellar stroke, spontaneous coronary artery dissection, or...

1 of 4