Abstract
The aim of preventive treatment of episodic and chronic migraine is the reduction of the frequency and severity of attacks and thereby the improvement of the patient’s quality of life. It is estimated that 38% of patients with migraine would benefit from preventive treatment, whereas in clinical practice only about 13% of them receive it. The intolerable side effects and low efficacy of pharmacological treatment are the main reasons for the discontinuation of treatment. It is suggested that calcitonin-gene-related-peptide (CGRP) plays a critical role in migraine patophysiology. Despite the fact that the effectiveness of CGRP antagonists in the treatment of migraine has been demonstrated in clinical trials, further research on CGRP antagonists has been suspended due to safety concerns regarding their toxic effects on the liver. In recent decades a new class of drugs has been developed, i.e. monoclonal antibodies against CGRP. To date, four monoclonal antibodies have demonstrated efficacy in phase two and three of clinical trials, significantly reducing the number of migraine days experienced by subjects per month versus the placebo. Moreover, they are effective more quickly than the currently available preventive treatments. Monoclonal antibodies have a favorable safety profile, which is similar to that of the placebo groups. No toxic effects on the liver or negative influences on hemodynamic or laboratory parameters have been reported and the discontinuation rates due to adverse events in patients treated with monoclonal antibodies were low. Despite these advantages, the long-term efficacy and safety of CGRP monoclonal antibodies remains unknown and more studies are needed.