Comparing the Efficacy, Safety, and Superiority of Calcitonin Gene-Related Peptide Monoclonal Antibodies and Botox in Preventing and Treating Migraines

Abstract

Both calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) and OnabotulinumtoxinA (botox) are used in the prevention of chronic migraines. However, it is not clear which is more effective overall. This review will compare the efficacy, side effects, cost-effectiveness, and other factors between CGRP mAbs and botox. We searched Pubmed and Google Scholar using the keywords migraines, CGRP mAbs, botox, efficacy, side effects, aura. All articles, including case-control/cohort studies, case series, case reports, randomized control trials, traditional/systematic reviews, were analyzed. CGRP mAbs and botox both reduce the frequency of migraines in patients. Patients have reported they decreased migraines' frequency and intensity in several studies after being given each medication. While CGRP mAbs are more recent medications, botox has been studied for more than a decade as a migraine preventative. Both drugs have minor short-term side effects, but some CGRP mAbs may cause persistent constipation too. CGRP mAbs are self-injected every month, and botox is physician-injected every three months, making it easier to stay compliant. While both medications are expensive, botox has a lower cost over time. Botox is more effective prophylaxis of migraines based on the articles that were reviewed. While both CGRP mAbs and botox are efficacious and tolerable, botox has been studied longer, has fewer side effects, is more cost-effective, and is easier to comply with.

Applications of Ketogenic Diets in Patients with Headache: Clinical Recommendations

“…Hence, most of the preventive treatments are characterized by a relatively low responder rate (so, patients will require more preventive medications concomitantly), potentially dangerous drug-drug interactions, and several side effects that result in high rates of switching or discontinuing treatment [8]. The most recent biological treatments (OnabotulinumtoxinA and monoclonal antibodies against calcitoningene-related peptide (CGRP)) showed a better profile of safety, but they are not indicated for all patients and concerns have been raised about cost/effectiveness [9]. Moreover, these innovative treatments are not effective in all patients that try them.…”

Comparative Long-Term Effectiveness Of OnabotulinumtoxinA (Botox) And Anti CGRP In Migraine Prevention: A Systematic Review

“…Every sixth participant reported fewer headaches without significant side effects. 49 Anti-CGRP mechanism of action One significant neurotransmitter connected to migraines is CGRP. Monoclonal antibodies and anti-CGRP agonists are effective migraine preventives.…”

“…As a result, patients can follow their treatment regimens. 49 Botox versus anti-CGRP BoNT-A and CGRP monoclonal antibodies are used to treat CM. This section will examine the viability, side effects, cost-effectiveness, and other factors of CGRP mAbs and BoNT-A.…”

“…This section will examine the viability, side effects, cost-effectiveness, and other factors of CGRP mAbs and BoNT-A. 49 A total of 1,672 patients were randomly assigned to groups that received varying doses of galcanezumab and a placebo. A total of 1,672 individuals were randomized randomly to receive either galcanezumab at a dosage or a placebo.…”

Management of chronic migraine

“…Expense and availability have been areas of concern with the advent of the CGRP antagonists, which were the first migraine specific medications developed in several decades. In the US, these drugs were approved starting in 2018 and priced at a similar annual cost to onabotulinumtoxin A, but their use was initially limited by insurance company coverage 44. Elsewhere in the world, approval and availability were delayed.…”