Date of Award

Spring 2023

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Kauffman, Russell

Keywords

migraine prevention, episodic migraines, CGRP mAbs, Propranolol, Amitriptyline, Topiramate, Eptinezumab, Galcanzumab, Fremanezumab, Erenumab

Abstract

The purpose of this research study is to determine if anti-calcitonin gene related peptide monoclonal antibodies (CGRP mAbs) more effective and tolerable in reducing the number of migraine days in comparison to conventional migraine prophylactic use of Propranolol, Amitriptyline, and Topiramate. Migraines are debilitating and a frequent reason for primary care visits interfering with an individual’s work, school, and daily life. Standard of care treatment options for migraine prophylaxis are drugs initially developed for other diseases and can lead to unnecessary and unwanted side effects decreasing treatment adherence in the prevention of migraines. In this literature review, electronic search databases including PubMed and CINAHL were used to search for clinical trials and randomized controlled trials. A variety of keywords and mesh terms were used to define a set of the literature regarding the use of CGRP mAbs in the prevention of episodic migraines as compared to standard treatments. Literature chosen for review were published after 2004. Sources were excluded if published prior to 2004, addressed prevention of chronic migraines, included small-molecule CGRP receptor antagonists, were conducted on children/adolescents, or included any conventional treatments not being investigated, such as onabotulinumtoxinA. The research selected and reviewed for this project demonstrated that conventional migraine prophylaxis treatments are not well tolerated and have poor adherence rates. Calcitonin gene-related peptide monoclonal antibodies are proven effective in the prevention of episodic migraines and improvement of quality of life when compared to placebo. However, more research is needed with head-to head trials of CGRP mAbs in direct comparison to standard prophylactic migraine medications in order to determine which is more effective and tolerable.

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