CGRP therapy for migraine
A group of newer medicines that block a protein called CGRP, given by injection or infusion (or sometimes as tablets) to help prevent migraine attacks in people who have not responded to other preventives.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- CGRP medicines block a protein involved in migraine to help prevent attacks; they are given by injection, infusion or, for gepants, as tablets.
- They are preventive treatments for people who have not responded to several other preventives, not a cure or a treatment for a single attack (except some gepants).
- On the NHS they are recommended only when at least three previous preventives have failed, under NICE criteria.
- Response is usually judged after about 3 months, and treatment is stopped if migraine days do not fall enough.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Can reduce the number of migraine days each month, often by around half when they work.
People who have not tried or cannot have the required number of other preventive treatments under NICE criteria.
You can carry on as normal. The injection site may be a little red or sore. Some people notice early benefit, but it often takes longer.
Accurate migraine-day counting to judge response objectively.
You can carry on as normal. The injection site may be a little red or sore. Some people notice early benefit, but...
Any benefit usually builds gradually. Side effects such as constipation or injection-site reactions may appear...
Injections continue monthly or quarterly, or tablets daily, while you keep a headache diary to track migraine days.
A common point to judge the response. Treatment is usually stopped if migraine days have not fallen enough.
What is CGRP therapy for migraine?
CGRP therapy is a group of newer medicines that target a protein called calcitonin gene-related peptide, or CGRP, which is involved in migraine attacks. By blocking CGRP or its receptor, these medicines aim to reduce how often migraines happen.
There are two main groups. The first is monoclonal antibodies (erenumab, fremanezumab, galcanezumab and eptinezumab). Most are given as a subcutaneous injection monthly or every three months; eptinezumab is given as a drip (infusion) into a vein. The second group, called gepants (such as atogepant and rimegepant), are tablets; some can be used both to prevent and to treat attacks.
These are preventive treatments designed specifically for migraine. They do not cure it, but they reduce migraine days for many people, often by around half when they work. They do not work for everyone.
On the NHS, CGRP treatments are recommended only when several other preventive medicines have already failed, and treatment is reviewed and stopped if it does not help enough.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
CGRP antibodies vs gepants
| Feature | Antibodies | Gepants |
|---|---|---|
| How taken | Injection or infusion | Tablets |
| How often | Monthly or quarterly | Daily or as needed |
| Use | Prevention | Prevention and some for attacks |
| Onset | Builds over weeks | Can act sooner for attacks |
Both target the CGRP pathway. Choice depends on your migraine pattern, preferences and NICE criteria.
Preparing for your treatment
- Make sure your diagnosis and migraine frequency are clear, and that you meet the criteria for treatment.
- Keep a headache diary so migraine days can be counted before and during treatment.
- List all your medicines, and mention any heart, blood pressure or circulation problems.
- Tell the clinician if you are pregnant, planning pregnancy or breastfeeding, as safety in pregnancy is not established.
- Discuss any history of constipation, which can occur or worsen with some of these medicines.
- Ask whether you will inject at home and arrange training and safe storage (some need refrigeration).
- Plan how repeat prescriptions, reviews and monitoring will be organised.
What happens
For the injectable antibodies, treatment is usually given as a small injection under the skin of the thigh, tummy or upper arm. After training, many people give these to themselves at home, monthly or every three months. The injection itself takes only a minute or two.
Eptinezumab is given differently, as an infusion into a vein over a period of time in a clinic, usually every three months.
Gepants are taken as tablets, either daily for prevention or, for some, when an attack starts.
Whichever treatment is used, you keep a headache diary so the effect can be measured. Benefit usually builds over weeks, and the response is reviewed after about three months to decide whether to continue.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- People who have not tried or cannot have the required number of other preventive treatments under NICE criteria.
- Those who are pregnant, planning pregnancy or breastfeeding, where safety is not established.
- People with significant uncontrolled high blood pressure, for treatments where this is a concern, until reviewed.
- People with untreated medication-overuse headache, which should be addressed alongside treatment.
Delay or rearrange if…
- Pregnancy, planned pregnancy or breastfeeding, until discussed.
- Uncontrolled high blood pressure that needs managing first.
- Significant constipation or bowel problems that need addressing.
- An uncertain diagnosis or migraine-day count that needs clarifying.
Alternatives to discuss
- Oral preventive medicines such as propranolol, topiramate or amitriptyline.
- Botulinum toxin for chronic migraine where criteria are met.
- Occipital nerve blocks in selected people.
- Lifestyle measures, trigger management and acupuncture.
- No treatment, with review, if the balance of benefit and burden is unclear.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Can reduce the number of migraine days each month, often by around half when they work.
- Designed specifically for migraine, unlike many older preventives borrowed from other conditions.
- Convenient dosing: monthly or quarterly injections, or tablets, with many injectables self-administered.
- May reduce the severity of attacks and reliance on painkillers.
- An option when several other preventive medicines have not worked or were not tolerated.
Risks & complications
- Injection-site reactions such as redness, pain or itching.
- Constipation, which can occur and is sometimes troublesome, particularly with erenumab.
- Muscle spasms or aches.
- Treatment not working well enough, in which case it is stopped.
- Itching or rash.
- Raised blood pressure, which may need monitoring with some treatments.
- Tiredness or other general side effects.
- Reactions during or after an infusion, for the infused treatment.
- Severe constipation that has needed hospital care in a small number of cases.
- Allergic or hypersensitivity reactions, including swelling of the face or throat (seek urgent help).
- Unknown long-term effects, as these are relatively new medicines.
- Possible risks in pregnancy, which are not established.
These are newer medicines, so long-term safety data are still building. Constipation can be a real problem for some people, occasionally severe, and is worth raising early. Blood pressure may need monitoring with some treatments. Because safety in pregnancy is not established, reliable contraception and a clear plan around pregnancy should be discussed before starting.
Published figures to discuss
CGRP treatments help some people substantially and others little, and the size of benefit varies. Trials show meaningful average reductions in migraine days, which is why NICE uses defined response thresholds and stopping rules. Side effects are usually mild, though constipation can be troublesome and long-term data are still building. Individual outcomes cannot be predicted from a single figure.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| NICE response threshold | Usually continue only if migraine days fall by at least 30% in chronic migraine or 50% in episodic migraine, depending on treatment guidance | A headache diary is essential to judge this honestly. | NICE TA682 - Erenumab for preventing migraine (recommendations)nice.org.ukPublished figure |
| Constipation, injection-site reactions or nausea | Recognised and usually manageable | Constipation can be clinically important with some CGRP medicines and should be asked about directly. | Guide sourcesClinical context |
| Non-response | Common enough to plan for | Some patients respond dramatically and others little; switching drug class or target may be considered. | Guide sourcesClinical context |
| Pregnancy and breastfeeding uncertainty | Clinically important | People who could become pregnant need explicit contraception and treatment-stop advice. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery. 'Afterwards' is about whether your migraine days fall over the following weeks and months, and managing any side effects.
- Mild injection-site redness or soreness.
- Constipation or muscle aches in some people.
- A gradual reduction in migraine days rather than an immediate change.
- Keeping a diary and waiting about three months to judge the effect.
Aftercare
- Take or inject the treatment exactly as directed, and store injectables correctly.
- Keep your headache diary so the response can be measured.
- Report side effects, especially constipation or raised blood pressure, rather than just stopping.
- Keep acute painkiller use within safe limits to avoid medication-overuse headache.
- Use reliable contraception and discuss pregnancy plans if relevant.
- Attend reviews so the benefit can be assessed at around three months and beyond.
- Know how to get urgent help for signs of an allergic reaction.
- Confirm you meet the NICE criteria for CGRP treatment.
- Start or continue a headache diary to count migraine days.
- Arrange injection training and safe storage if self-injecting.
- List your medicines and note any constipation or blood pressure issues.
- Discuss contraception and pregnancy plans if relevant.
- Save the contact route for side effects and prescriptions.
⚠ Get urgent help if…
- Signs of a serious allergic reaction such as swelling of the face, lips or throat, widespread rash or difficulty breathing (seek emergency care).
- Severe or persistent constipation, especially with abdominal pain or vomiting.
- A markedly raised blood pressure reading or symptoms such as severe headache that is different from your migraines.
- A reaction during or after an infusion.
- Spreading redness, swelling or infection at an injection site.
- Any new neurological symptoms such as weakness, numbness or vision changes.
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
When CGRP therapy works, people usually notice fewer migraine days each month, often around a halving, and sometimes milder attacks and less need for painkillers. The benefit builds over weeks rather than appearing immediately.
NICE guidance uses defined response thresholds: in episodic migraine, treatment is generally stopped if migraine frequency does not fall by at least 50%, and in chronic migraine if it does not fall by at least 30%, usually assessed at around three months. This is why an accurate headache diary is essential: it is how benefit is judged. These medicines reduce migraine burden; they do not cure migraine.
CGRP treatments work while they are being taken, so continued dosing is needed to maintain benefit. Because they are relatively new, long-term data are still accumulating. Many services review treatment periodically and may pause it after a period to check whether it is still needed, as some people's migraines improve over time.
Related tests, treatments or support
CGRP therapy is used as part of overall migraine care, alongside lifestyle measures and acute attack treatments kept within safe limits. On the NHS it is generally not combined with botulinum toxin without specialist criteria. Your specialist decides how it fits with any other treatments and how switching between options is handled.
Follow-up & long-term care
Follow-up is central, because the response is judged at around three months and treatment continued only if it helps enough. Reviews check migraine days, side effects, blood pressure where relevant, and ongoing need. Make sure you know who prescribes and reviews your treatment, how response is measured, and how to get help with side effects.
- Continue regular dosing while the treatment helps.
- Keep a headache diary to track migraine days over time.
- Monitor blood pressure where advised, and report constipation early.
- Review the response at around three months and periodically thereafter.
- Discuss planned breaks to check whether treatment is still needed.
- Keep acute medicine use within safe limits.
Repeat, follow-on and what comes next
- Treatment is stopped if migraine days do not fall enough (at least 50% in episodic or 30% in chronic migraine).
- Switching between CGRP treatments is sometimes tried if one does not suit.
- Treatment may be paused after a period to check it is still needed.
- Doses and choice may be adjusted based on response and side effects.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Accurate migraine-day counting to judge response objectively.
- A clear review at around three months with a defined stopping rule.
- Monitoring of side effects, including constipation and blood pressure where relevant.
- A named contact route for side effects and prescriptions, and coordination with your GP.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Which CGRP treatment is used, as costs differ between medicines.
- Whether it is an injection, an infusion or tablets, and how often it is given.
- Infusions add a clinic or facility fee and staff time.
- The specialist's fees for assessment, training and review.
- Any monitoring, such as blood pressure checks, that is needed.
- Whether ongoing prescribing and follow-up are included.
- The cost of the medicine and how often it is needed.
- Any clinic or facility fee for infusions.
- Whether assessment, injection training and follow-up are included.
- What happens, and what it costs, if treatment is stopped for lack of benefit.
- Whether monitoring and communication with your GP are included.
- The cancellation and rebooking policy.
On the NHS? CGRP treatments are available on the NHS only when NICE criteria are met (usually at least three previous preventives failed); otherwise they are accessed privately, and the decision should always be clinical.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not confirming the diagnosis and migraine-day count against the criteria.
- Not discussing constipation and blood pressure monitoring.
- Not raising pregnancy and contraception, given uncertain safety.
- Implying a cure rather than a possible reduction in migraine days.
- Not explaining the response threshold and stopping rule.
Marketing red flags
- Promoting CGRP treatment as a guaranteed cure for migraine.
- Offering it without confirming the NICE eligibility criteria.
- Downplaying side effects such as constipation or the lack of long-term data.
- Not mentioning the need to review response and stop if it does not help.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Do I meet the NICE criteria, and which CGRP option suits my migraine pattern?
- How will we measure whether it is working, and when would we stop?
- What side effects should I watch for, especially constipation and blood pressure?
- How does this compare with Botox or other options for me?
- If I am of childbearing age, what should I do about contraception and pregnancy plans?
- Who will prescribe, train and review me, and how do I get help with side effects?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Can I get CGRP treatment on the NHS?
How are these medicines given?
How will I know if it is working?
What are the main side effects?
Are they safe in pregnancy?
Are these the same as Botox for migraine?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: The Migraine Trust - CGRP monoclonal antibodies NICE TA682 - Erenumab for preventing migraine (recommendations) NICE - Atogepant for preventing migraine The Migraine Trust - Q&A: CGRP medication NHS - Migraine treatment An Update on CGRP Monoclonal Antibodies for Episodic Migraine - PMC
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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