Which agent is a CGRP antagonist used for cluster headache prophylaxis?

Which agent is a CGRP antagonist used for cluster headache prophylaxis?

• A. Verapamil
• B. Lithium
• C. Corticosteroids
• D. Galcanezumab

Answer: (D)

CGRP plays a key role in the trigeminovascular system and its release contributes to the attacks seen in cluster headache. Blocking this peptide can reduce attack frequency, making CGRP-targeted therapies effective for prevention. Galcanezumab is a monoclonal antibody that binds CGRP, preventing it from activating its receptor, and is used to prevent cluster headache attacks. This mechanism directly targets the pathophysiology of the condition, which is why it’s the best choice among the options listed. Other agents listed work through different pathways—verapamil as a calcium-channel blocker, lithium as a mood-stabilizing/alternative prophylactic, and corticosteroids as anti-inflammatory bridging therapy—so they are not CGRP antagonists. Galcanezumab is typically given by monthly subcutaneous injection and has demonstrated a reduction in attack frequency in cluster headache patients.

CGRP plays a key role in the trigeminovascular system and its release contributes to the attacks seen in cluster headache. Blocking this peptide can reduce attack frequency, making CGRP-targeted therapies effective for prevention. Galcanezumab is a monoclonal antibody that binds CGRP, preventing it from activating its receptor, and is used to prevent cluster headache attacks. This mechanism directly targets the pathophysiology of the condition, which is why it’s the best choice among the options listed. Other agents listed work through different pathways—verapamil as a calcium-channel blocker, lithium as a mood-stabilizing/alternative prophylactic, and corticosteroids as anti-inflammatory bridging therapy—so they are not CGRP antagonists. Galcanezumab is typically given by monthly subcutaneous injection and has demonstrated a reduction in attack frequency in cluster headache patients.