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Calcitonin gene related peptide in migraine: current therapeutics, future implications and potential off-target effects
  1. Jason Charles Ray1,2,
  2. Mahima Kapoor1,2,
  3. Richard J Stark1,2,
  4. Shuu-Jiun Wang3,4,
  5. Lars Bendtsen5,6,
  6. Manjit Matharu7,
  7. Elspeth Jane Hutton1,2
  1. 1Neurology, Alfred Health, Melbourne, Victoria, Australia
  2. 2Department of Neuroscience, Monash University, Clayton, Victoria, Australia
  3. 3The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
  4. 4Brain Research Center, National Yang-Ming University, Taipei, Taiwan
  5. 5Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Glostrup, Denmark
  6. 6University of Copenhagen, Kobenhavn, Denmark
  7. 7Headache Group, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
  1. Correspondence to Dr Jason Charles Ray, Neurology, Alfred Health, Melbourne, VIC 3004, Australia; j.ray{at}


Migraine is the second largest cause of years lost to disability globally among all diseases, with a worldwide prevalence over 1 billion. Despite the global burden of migraine, few classes of therapeutics have been specifically developed to combat migraine. After 30 years of translational research, calcitonin gene-related peptide (CGRP) inhibitors have emerged as a promising new tool in the prevention of migraine. Like all new therapeutics; however, we have limited real-world experience and CGRP has several known systemic actions that warrant consideration. This article provides a narrative review of the evidence for CGRP antagonists and summarises the known and potential side effects that should be considered.

  • migraine
  • migraine
  • drug trials
  • headache

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  • Contributors EJH and JCR were primarily responsible for study concept and design. JCR was responsible for review of literature and primary writing and preparation of the manuscript. MK provided substantial review and editing of manuscript. MM, LB, RJS and S-JW all provided additional expertise in review, editing and input into manuscript content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MM serves on the advisory board for Allergan, Novartis, Eli Lilly, Autonomic Technologies and TEVA and has received payment for the development of educational presentations from Allergan, electroCore, Eli Lilly, Novartis and TEVA. RJS has been a member of Advisory Boards for Allergan, Novartis, Teva and Eli Lilly and has received Lecture Fees from Allergan, Novartis, Teva and Eli Lilly and Biogen. EJH has served on advisory boards for Sanofi-Genzyme, Novartis, Teva, Eli Lilly, Allergan, been involved in clinical trials sponsored by Novartis and Teva, and has received payment for educational presentations from Allergan, Teva, Eli Lilly and Novartis. S-JW has served on the advisory boards of Eli Lilly, Daiichi-Sankyo and Taiwan Norvatis. He has received honoraria as a moderator from Allergan, Pfizer, Eli Lilly, Bayer, and Eisai. He has received research grants from the Taiwan Minister of Technology and Science, Brain Research Center, National Yang-Ming University from The Featured Areas Research Center Programme within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan, Taipei Veterans General Hospital, and Taiwan Headache Society. LB serves on the advisory board for Allergan, Novartis, Eli Lilly and Teva, has been involved in clinical trials sponsored by Novartis and has received payment for educational presentations from Allergan, Teva and Novartis. JR and MK report no potential conflict of interest. Figure created with

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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