Alpha-CGRP

Where it comes from

Made in

Sensory neurons, trigeminal ganglion above all; also nerves around every artery and in the gut

Sent out by

Nerve activation: pain, heat, capsaicin, and the trigeminal firing of a migraine attack

Acts on

• Arteries of the head and heart
• Dura and trigeminal nerve
• Mast cells
• Bone cells

What it does

• Dilates arteries as potently as any substance of the body ¹
• Carries the pain and vessel changes of migraine
• Takes part in the flare of inflamed skin and in bone healing

In medicine

• Four antibodies against CGRP or its receptor (erenumab, fremanezumab and galcanezumab in 2018, eptinezumab in 2020) are approved to prevent migraine; the first of them cut monthly migraine days by 3.2 against 1.8 on placebo ³⁴
• The gepants (ubrogepant, rimegepant, atogepant, zavegepant), approved from 2019 to 2023, block the receptor by tablet or nasal spray for attacks and prevention
• An infusion of CGRP brings on a migraine in people prone to it, the experiment that proved its role ²

Beyond the body’s own use

• Galcanezumab is also approved to prevent episodic cluster headache, the one use any of these medicines has outside migraine
• Erenumab’s label now warns of new or worsening high blood pressure and of Raynaud’s phenomenon, both added after marketing: CGRP is the circulation’s relaxer of last resort, and blocking it for years is still being watched ⁴
• Nothing here is used outside medicine. An infusion of the peptide only brings on a headache ², and the blockers are prescription injections and tablets; blockade beyond migraine, in post-traumatic headache above all, is still in trials