CGRP, PACAP & Beyond: The Future of Migraine Relief

Day 8 (2026)

Key Questions

What has been the clinical impact of CGRP inhibitors in migraine treatment so far?
How many people with migraine respond to CGRP inhibitors, and what are the main challenges for non-responders?
Should efficacy of CGRP inhibitors be measured only by reduction in attack frequency?
Are there biomarkers that reliably predict response to CGRP inhibitors?
Which new peptides —PACAP, adrenomedullin, and amylin — are being studied, and how could treatments targeting them differ from CGRP inhibitors?
How are new drug targets identified and potential migraine treatments tested?
How do the different pain fiber pathways — A-delta (targeted by CGRP inhibitors) and C-fibers (targeted by Botox) — influence treatment decisions?
How should treatment decisions about combining therapies, like CGRP monoclonal antibodies and Botox, balance randomized trial evidence with real-world clinical experience?
Which emerging migraine treatments are in advanced clinical trials?
What can people with migraine do while awaiting the next major treatment breakthrough?

Interview Notes

Treatments Mentioned

OnabotulinumtoxinA (Botox)
CGRP inhibitors
CGRP monoclonal antibodies (mAbs)
CGRP small-molecule receptor antagonists (gepants)
Opioids
PACAP (pituitary adenylate cyclase-activating polypeptide) inhibitors *Currently in clinical trials

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Disclaimer: The Migraine World Summit aims to bring you a variety of perspectives and expertise, free from bias or judgment. Alternative theories presented in this video have not been medically reviewed. Views expressed in this interview do not necessarily represent the views of the Migraine World Summit. Please always consult your health care professional and do your own research before making changes to your treatment plan.

Expert

Messoud Ashina, MD, PhD, DMSc

Professor of Neurology | Centre Leader
Danish Headache Center | Center for Discoveries in Migraine

Messoud Ashina, MD, is a professor of neurology in the faculty of health and medical sciences, University of Copenhagen, Denmark. Professor Ashina received his doctor of medicine degree at the Azerbaijan Medical University. He completed his residency in neurology at the University of Copenhagen. Dr. Ashina received his PhD and DMSc degrees at the University of Copenhagen.

He is director of the Center for Discoveries in Migraine at the Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup.

Professor Ashina has been actively involved in headache research since 1995. His research interests include experimental migraine and cluster headache models, neuroimaging, novel antimigraine drug targets, the mechanism of migraine, and the action of antimigraine medications. He has authored over 600 papers, abstracts, and book chapters on the topic of headache, including migraine and cluster headache.

Professor Ashina serves as associate editor of two journals: Brain, and The Journal of Headache and Pain. He is also past president of the International Headache Society.