Aimovig, Ubrelvy, and More: 8 CGRP Antagonists and How They Compare for Migraines
Key takeaways:
Calcitonin gene-related peptide (CGRP) antagonists are medications that treat and prevent migraines. There are several options available, including oral pills, injections, and a nasal spray.
Common injectable CGRP antagonists include Aimovig (erenumab), Ajovy (fremanezumab), and Emgality (galcanezumab). Ubrelvy (ubrogepant), Nurtec ODT (rimegepant), and Qulipta (atogepant) are all oral options.
The CGRP antagonist that you’re prescribed will depend on the frequency and severity of your migraine symptoms. You and your healthcare provider can work together to decide which treatment is right for you.
Table of contents
Migraines can cast a cloud over daily life, affecting your work, relationships, and other areas of your life. If you find yourself trapped in a cycle of debilitating headaches, light sensitivity, and nausea, you’re not alone.
Thankfully, there are many medications that can help you manage migraine symptoms. A newer class of medications called calcitonin gene-related peptide (CGRP) antagonists are an increasingly popular choice for preventing and treating migraines.
CGRP antagonists work by blocking the effects of CGRP, a protein that can trigger migraines. Some are oral pills, while others are monoclonal antibodies that are injected or infused into your body. There is also a nasal spray available. Below, we provide a list of eight CGRP antagonists and what you need to know about each one.
1. Aimovig
Aimovig (erenumab) is FDA approved for preventing (rather than treating) migraine attacks in adults. It’s a monoclonal antibody that works by binding to CGRP receptors (chemical binding sites) to prevent the protein from attaching and triggering migraine headaches.
Aimovig is injected under the skin (subcutaneously) once a month. It comes as a prefilled autoinjector or syringe. You can inject the medication into your stomach or the front of your thighs. If you don’t want to inject the medication yourself, you can also have another person inject it in the back of your upper arm.
Aimovig is generally well tolerated. But there are a few potential side effects to know about. Common Aimovig side effects include injection site reactions and mild constipation. Muscle cramps and spasms have also been reported, but they are less common.
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More serious side effects are possible with Aimovig, especially after the first dose. Serious side effects include severe constipation and high blood pressure. Typically, people who report high blood pressure after starting treatment with Aimovig have a history of hypertension. The risk may also be higher if you’ve had other heart problems in the past.
2. Ajovy
Like Aimovig, Ajovy (fremanezumab) is a monoclonal antibody used to prevent migraines in adults. But Ajovy blocks the effects of CGRP in a different way. While Aimovig binds to CGRP receptors, Ajovy binds to the CGRP molecule itself. Because of this, Ajovy may be more effective than Aimovig for some people.
Ajovy is injected under the skin in the same areas of the body as Aimovig. You can inject it once monthly or once every 3 months using a prefilled autoinjector or syringe. If doing injections less often is appealing to you, Ajovy may be a good option.
Injection site reactions are the most common Ajovy side effect. In fact, compared with other CGRP antagonists, Ajovy has the highest rate of injection site reactions. Although rare, immune system reactions have been reported, too.
3. Emgality
Like Ajovy, Emgality (galcanezumab) is a monoclonal antibody that blocks CGRP to help prevent migraines in adults. But unlike Ajovy, Emgality can also be used to treat cluster headaches, a type of headache associated with severe pain on one side of the head.
This medication is injected under the skin monthly in the same areas of the body as Ajovy. Common Emgality side effects include injection site reactions and common cold symptoms, such as sore throat and runny nose. Back and joint pain have also been reported, but these side effects are less common.
4. Vyepti
Vyepti (eptinezumab) is another monoclonal antibody that prevents migraines. By binding to the molecule, it prevents CGRP from attaching to and activating CGRP receptors.
This medication isn’t injected under the skin, however. It’s given as an infusion into a vein (IV) every 3 months. Each Vyepti infusion takes about 30 minutes to receive and starts working relatively quickly.
Side effects aren’t common with Vyepti, but it’s possible to experience common cold symptoms, flushing, and itching. Most Vyepti side effects are mild and typically occur during or shortly after the infusion.
Keep in mind: If you experience serious or bothersome side effects during your Vyepti infusion, tell your medical team right away. They can give you medication to help manage your reaction. And if you notice signs of a reaction after you return home from the infusion center, go to the nearest emergency room.
5. Ubrelvy
As mentioned, some CGRP antagonists come in an oral form. Ubrelvy (ubrogepant) was the first FDA-approved oral CGRP medication (“gepant”) for migraine treatment. Unlike the medications discussed above, it’s not used to prevent migraines.
Ubrelvy is approved to treat migraines in adults. It’s an oral tablet that should be taken with a glass of water and swallowed whole. If you’re prescribed Ubrelvy, you should take a dose at the first sign of migraine symptoms, which might include painful headaches, nausea, or sensitivity to light or sound. If you still have migraine symptoms after 2 hours, you can take another Ubrelvy dose. You shouldn’t take more than 2 doses in 24 hours, however.
Ubrelvy was well tolerated in clinical trials. The most common side effect was nausea. Sleepiness and dry mouth were also reported.
6. Nurtec ODT
Nurtec ODT (rimegepant) is the first and only orally disintegrating tablet (ODT) CGRP antagonist. It can treat and prevent migraines in adults, and it’s designed to work quickly. This is convenient if you need immediate relief from a migraine attack or have trouble keeping food or liquids down due to nausea.
To take Nurtec ODT, you let it dissolve on or under your tongue instead of swallowing it whole. If you’re using it for migraine treatment, you can take one tablet daily. But if you’re using it for migraine prevention, you can take a tablet once every other day.
Like Ubrelvy, Nurtec ODT is generally well tolerated. Common Nurtec ODT side effects include mild nausea, stomach pain, and indigestion.
7. Qulipta
Qulipta (atogepant) is another oral CGRP antagonist used to prevent migraine headaches in adults. It’s available as a standard oral tablet, just like Ubrelvy. Your healthcare provider may recommend taking Qulipta daily to ward off migraine symptoms.
Common side effects of Qulipta include nausea, constipation, and fatigue. Dizziness, appetite changes, and weight changes can also happen, but these side effects tend to be less common. Most Qulipta side effects are mild and go away over time.
8. Zavzpret
Zavzpret (zavegepant) is the newest CGRP antagonist used for migraine treatment in adults. It works similarly to Ubrelvy and Nurtec ODT, but it’s a nasal spray. It works relatively quickly, too.
The typical dosage is one spray in one nostril at the first sign of migraine symptoms. You shouldn’t administer more than one spray in 24 hours.
Zavzpret was well tolerated in clinical studies. Common Zavzpret side effects that are mild include nasal discomfort and temporary taste changes. Other common side effects include nausea and vomiting.
How do I know which CGRP antagonist is right for my migraines?
With migraines, the triggers, symptoms, and steps that lead to feeling better can differ from person to person. As a result, one migraine medication isn’t considered better than the rest.
Your healthcare provider can help you choose the right CGRP antagonist based on your preferences, the other medications you’ve already tried, and the frequency and severity of your symptoms. Which options are affordable and covered by your health insurance may also play into your decision.
The bottom line
There are many different calcitonin gene-related peptide (CGRP) antagonists available to prevent and treat migraines. Popular injectable CGRP antagonists include Aimovig (erenumab), Ajovy (fremanezumab), and Emgality (galcanezumab). There are also oral alternatives such as Ubrelvy (ubrogepant), Nurtec ODT (rimegepant), and Qulipta (atogepant). But which CGRP antagonist your healthcare provider recommends will depend on your preferences and symptoms. It’s also important to consider your insurance coverage to determine the right treatment for you.
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References
Aditya, S., et al. (2023). Advances in CGRP monoclonal antibodies as migraine therapy: A narrative review. Saudi Journal of Medicine & Medical Sciences.
Datta, A., et al. (2021). A review of eptinezumab use in migraine. Cureus.
Lundbeck Pharmaceuticals LLC. (2022). Vyepti - eptinuzumab-jjmr injection [package insert]. DailyMed.
Pfizer, Inc. (2023). Pfizer’s ZAVZPRET™ (zavegepant) migraine nasal spray receives FDA approval.
Wang, X., et al. (2022). Efficacy and safety of monoclonal antibody against calcitonin gene-related peptide or its receptor for migraine patients with prior preventive treatment failure: A network meta-analysis. The Journal of Headache and Pain.
