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

Mariah Siddiqui,Parth V Shah,Prachi Balani,Angel R Lopez,Chelsea Mae N Nobleza,Safeera Khan

doi:10.7759/cureus.13002

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.

Highlights

BackgroundStudies show that 15%-17% of women and 6% of men suffer from migraines [1]
Twenty-nine articles that were relevant to our review were used in this article using the criteria mentioned above, along with choosing articles that analyzed the efficacy of calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) and botox in regards to migraines
CGRP mAbs and botulinum toxin are two recent interventions that seem to be more promising in preventing chronic migraines

Summary

Introduction

BackgroundStudies show that 15%-17% of women and 6% of men suffer from migraines [1]. A migraine is defined by a severe pulsing or throbbing sensation in the head unilaterally but may occur bilaterally. It is a neurovascular headache disorder which may be multifactorial, recurrent, and debilitating. Auras include increased sensitivity to light, sound, smell, and some migraines may even be associated with vomiting and nausea [2]. These prodrome symptoms can be due to several triggers such as alcohol, lack of eating, scents such as perfumes, hormones, stress, and weather [3]. Studies show that migraines may even cause referred pain to the body's external areas, such as the periorbital skin [7]

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Results

Conclusion