Migraine CGRP Therapies: Sex-Based Efficacy, Hormonal Influences, and Clinical Implications

DOI: 10.5281/zenodo.16371119

ABSTRACT

This episode investigates the role of sex differences in migraine and how they affect response to a revolutionary class of drugs—CGRP-targeted therapies. We unpack the underlying biology, including the impact of estrogen, the sensitivity of female trigeminal systems, and the broader concept of sexual dimorphism in pain processing. The conversation compares monoclonal antibodies (MABs) and small-molecule CGRP receptor antagonists (the “gepants”), highlighting why acute gepant treatments may be significantly more effective in women than men. We examine real-world efficacy data, FDA findings, pharmacokinetics, and the urgent need for sex-disaggregated clinical trial design. From foundational science to clinical practice, this episode offers a compelling case for precision medicine in migraine care.

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OBJECTIVES

1. What accounts for the higher prevalence and severity of migraine in females?

2. How do CGRP-targeted monoclonal antibodies (MABs) and gepants work differently?

3. What is the “estrogen withdrawal hypothesis” and how does it relate to migraine triggers in women?

4. What do pooled analyses reveal about the differing efficacy of acute gepants in men vs. women?

5. Are there pharmacokinetic or safety differences in CGRP therapies based on sex?

6. What explains the comparable efficacy of preventive CGRP therapies across sexes?

7. Why are most CGRP trials underpowered to detect sex-specific effects, especially in men?

8. How can future clinical trials and basic science better address sex-based biology in migraine research?

Join the conversation—Have you or someone you know experienced different responses to migraine treatments? Share your thoughts or questions below.

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https://health.conciercare.net/news/post/10.5281.cjn.16371119 - Funding & Ethical Disclosures

#Migraine, #CGRP, #SexDifferences, #PrecisionMedicine, #Neurology, #Hormones, #Estrogen, #Pharmacogenomics, #MABs, #Gepants, #TrigeminalSystem, #PainMedicine, #WomensHealth