The introduction of calcitonin gene-related peptide monoclonal antibodies represents a step forward in preventive migraine treatment as the first agents to target the underlying pathogenesis of migraine. In trials they act more quickly, have better long-term adherence and appear to be better tolerated than other treatments. Major disadvantages are their high cost and unknown safety in pregnancy and in cardiovascular disease. To mitigate these concerns, they should be used according to guidance produced by professional bodies, with defined starting and stopping criteria. We do not yet know whether they are more effective than standard care; many patients may still be better treated by other means, in particular addressing lifestyle factors and medication-overuse headache.
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Contributors NJG was commissioned and wrote the article.
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 The author received hospitality from Teva (fremanezumab) in 2019 and from Allergan (Botox) in 2018 (conference, hotel and flights). The author has never received honoraria from the CGRP monoclonal antibodies manufacturers, has no financial interests in them, and has not been involved in trials of these products.
Provenance and peer review Commissioned; externally peer reviewed by Stuart Weatherby, Plymouth, UK and Richard Stark, Melbourne, Australia.
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