What to Do if Your CGRP Treatment Doesn’t Help

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Key Questions
  • What is CGRP?
  • How is CGRP related to migraine?
  • What classes of medications that act on the CGRP pathway are now available for migraine?
  • How do these classes differ from one another?
  • What were the goals and findings of your research on CGRP monoclonal antibodies?
  • Why doesn’t everyone with migraine respond to CGRP-related medications?
  • Can the efficacy of CGRP-related medications wane over time?
  • What are some options for preventive and acute medications for those who don’t respond to a CGRP-related medication?
  • What should a patient do if a provider says that they have tried everything?
Interview Notes
Treatments Mentioned
  • Biofeedback
  • Celecoxib (Celebrex)
  • CGRP monoclonal antibodies (mAbs)
  • CGRP receptor antagonists (gepants)
  • Dihydroergotamine (DHE)
  • Dihydroergotamine mesylate (Trudhesa)
  • Ditans (selective 5HT1F receptor agonists)
  • Dodecyl maltoside (Intravail)
  • Eptinezumab (Vyepti)
  • Fremanezumab (Ajovy)
  • Ketamine
  • Lidocaine
  • Lifestyle factors (sleep, etc.)
  • LSD (lysergic acid diethylamide)
  • NSAIDs
  • OnabotulinumtoxinA (Botox)
  • Psilocybin
  • Topiramate (Topamax)
  • Triptans
  • Ubrogepant (Ubrelvy)

Please note: The Migraine World Summit’s aim is to bring you a variety of perspectives and expertise, independent of 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.

Peter McAllister, MD, FAAN

Medical Director
New England Institute for Neurology & Headache

Dr. Peter McAllister is board certified in neurology and headache medicine. He is the medical director of the New England Institute for Neurology and Headache and chief medical officer of the New England Institute for Clinical Research and Ki Clinical Research in Stamford, Connecticut.

Dr. McAllister is an associate professor of neurology at the Yale University School of Medicine and clinical professor of neurology and anatomy at the Frank H. Netter School of Medicine at Quinnipiac University. He is a Fellow of the American Academy of Neurology and an executive board member of the Headache Cooperative of New England.

He is recognized as a “Top Neurologist” by U.S. News & World Report and also listed as a “Top Doc” in Connecticut, metropolitan New York City, and Fairfield County. Dr. McAllister lectures internationally, has been a principal investigator on over 350 clinical trials, and has authored more than 100 articles and book chapters in the lay and scientific press.

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