Pharmacological properties and individualized selection of CGRP inhibitors for migraine prevention and acute treatment

This article reviews the clinical and pharmacological properties of calcitonin gene-related peptide (CGRP) inhibitors for migraine prevention and acute treatment. Monoclonal antibodies (erenumab, fremanezumab, galcanezumab, eptinezumab) and small-molecule receptor antagonists (ubrogepant, rimegepant, atogepant) have shown efficacy in episodic and chronic migraine. Current evidence shows that these drug classes reduce monthly migraine days, lower the need for symptomatic medications, and improve patient functional status. They also display favorable tolerability and safety profiles compared with conventional therapies, with minimal vascular effects. Early administration of ubrogepant and rimegepant at migraine onset increases the probability of pain and symptom relief, while monoclonal antibodies targeting CGRP are primarily indicated for long-term prevention. The pharmacokinetics, mechanisms of action, and dosing regimens of monoclonal antibodies and gepants are discussed. Key differences in the onset and duration of therapeutic effects between these groups are emphasized, which is essential for selecting individualized therapy in specific clinical scenarios. Study limitations, including short follow-up periods and restricted patient populations, highlight the need for further comparative research in real-world settings. The integration of CGRP inhibitors into migraine management protocols is supported, provided that therapy is tailored to optimize efficacy and safety.