25 Mar 2026
Discovered in 1982, CGRP was found to be produced from the same gene that produces calcitonin, a hormone involved in regulating calcium levels in the body. Researchers quickly realised that CGRP acts as a neuropeptide, primarily found in nerve cells, and plays a role in various bodily functions such as pain sensation, regulating blood pressure, and controlling gastrointestinal functions.
Discovered in 1982, CGRP was found to be produced from the same gene that produces calcitonin, a hormone involved in regulating calcium levels in the body. Researchers quickly realised that CGRP acts as a natural chemical found in nerve cells, and plays a role in various bodily functions such as pain sensation, regulating blood pressure, and controlling digestion.
Relationship between CGRP and Migraine
Current research strongly suggests that CGRP plays a crucial role in the onset of acute migraine attacks.
- Traditionally, migraine episodes were attributed to the dilation of brain blood vessels. However, investigations on both animals and human brain vessels have demonstrated that CGRP relaxes these vessels, potentially impacting blood flow.
- Further experiments involving cats and humans have revealed that stimulating specific nerves in the head can trigger the release of CGRP into the bloodstream.
- Additionally, studies have found that drugs like Sumatriptan, commonly used to alleviate migraines, can effectively reduce CGRP levels in the blood.
- Notably, direct infusion of CGRP into the bloodstream has been shown to induce symptoms similar to migraines.
Medications That Target the CGRP Pathway
Once the link between CGRP and migraines was established, medications were developed specifically to block it. In 2018, the FDA approved Erenumab as the first anti-CGRP treatment for migraines. Today, anti-CGRP therapy in Singapore and around the world has transformed migraine management, offering new hope for chronic sufferers. Currently, anti-CGRP medications fall into two classes
CGRP Receptor Antagonists (Gepants)
Gepants are taken as tablets and work by blocking the CGRP receptor, which is involved in transmitting pain signals and widening blood vessels during a migraine. By blocking this receptor, gepants prevent CGRP from triggering its effects, helping to reduce inflammation and pain. They can be used to treat a migraine attack as it happens, or taken regularly to prevent future attacks.
CGRP Monoclonal Antibodies (Zumabs)
These are laboratory-produced antibodies that attach to either the CGRP molecule or its receptor, preventing the interaction that triggers pain. By blocking CGRP, they help reduce inflammation and alleviate migraine symptoms. They are given as injections or infusions and are used for prevention rather than treating an attack in progress.
What Should I Expect When Taking an Anti-CGRP Medication?
These medications aim to reduce the frequency, severity, and duration of migraine attacks. Depending on the specific medication prescribed, you may experience relief within hours for acute attacks (gepants) or over several weeks to months for preventive treatment (zumabs).
CGRP monoclonal antibodies are commonly administered through injections, either subcutaneously (under the skin) such as Erenumab, Fremanezumab, and Galcanezumab, or intravenously like Eptinezumab. It’s essential to recognize that these medications don’t provide immediate relief. The timeframe for their effectiveness can vary widely among individuals. While some patients may experience improvement within a week of treatment initiation, others may require up to 6 months to observe noticeable benefits. As a result, it’s generally advisable to continue treatment for approximately 6 months to gauge its full impact.
What If Anti-CGRP Medications Do Not Work?
If you find that anti-CGRP medications are not providing the desired relief for your migraines, there are several alternative treatment options that your healthcare provider may recommend. This can include switching to another anti-CGRP medication, CGRP antagonist, or considering the use of BTX or nerve blocks for migraine treatment.
Additionally, your healthcare provider may suggest combining treatments or incorporating lifestyle modifications to enhance your migraine management. This could involve implementing stress management techniques, making dietary changes, engaging in regular exercise, ensuring adequate sleep, and identifying and avoiding migraine triggers.
Seeking Expert Care for Your Migraines
If you are considering anti-CGRP therapy in Singapore for your migraines, getting the right specialist makes all the difference.
Dr Christopher Liu is a trusted migraine specialist in Singapore based at Alleviate Pain Clinic, Farrer Park Hospital. With extensive experience in headache and facial pain conditions, he takes a thorough, patient-centred approach to every consultation, assessing your full medical history before recommending the most suitable treatment pathway for your needs. For more information on his practice, click here.
