Abstract Details

Title Edvinsson and Goadsby’s Challenge to Migraine Orthodoxy: The CGRP Turning Point

Topic History of Neurology

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 20-004

Objective To examine how Lars Edvinsson and Peter Goadsby’s work on calcitonin gene–related peptide (CGRP) redefined migraine pathophysiology and paved the way for the first targeted therapies.

Background For much of the 20th century, migraine was viewed primarily as a vascular disorder, with pain attributed to vasodilation rather than neuronal dysfunction. The discovery of CGRP in the early 1980s reframed our understanding of migraine biology. Edvinsson localized CGRP to cranial vessels and sensory neurons, while Goadsby demonstrated its release during migraine attacks. Together, their findings established migraine as a neurovascular process within the trigeminovascular system, challenging decades of conventional thinking and laying the groundwork for a new therapeutic paradigm.

Design/Methods A historical literature review was conducted using PubMed, Scopus, and Web of Science (1980–2024), with the search terms “CGRP,” “migraine,” “trigeminovascular,” and “monoclonal antibody.”

Results In the early 2000s, CGRP infusion studies demonstrated a direct causal link between the peptide and migraine attacks. Early small-molecule CGRP receptor antagonists (gepants) established proof of concept but were limited by hepatotoxicity, prompting development of safer oral agents. The subsequent approval of monoclonal antibodies targeting CGRP or its receptor after 2018 represented a paradigm shift toward mechanism-based, prophylactic migraine therapy. This represents one of neurology’s clearest examples of how a molecular discovery can translate into targeted, mechanism-based care.

Conclusions The evolution of CGRP research illustrates how meticulous scientific inquiry can overturn entrenched models and translate molecular discoveries into transformative clinical practice. Edvinsson and Goadsby’s contributions redefined migraine as a neurobiological disorder with identifiable, targetable pathways—ushering in a new era of rational, mechanism-driven therapy for headache medicine..

Authors/Disclosures
Brandon Dsouza, MBBS (Dr. D.Y. Patil Medical College, Hospital and Research Centre) PRESENTER	Dr. Dsouza has nothing to disclose.
Devansh B. Gupta, MBBS	Dr. Gupta has nothing to disclose.
Vitoria Acar, MD	Dr. Acar has received research support from Pfizer Brazil. Dr. Acar has a non-compensated relationship as a Volunteer/ advocacy with ABRACES that is relevant to AAN interests or activities.
Mateus D. Franco, MD	An immediate family member of Mr. Franco has received research support from Pfizer Brazil . Mr. Franco has received personal compensation in the range of $500-$4,999 for serving as a Second Lieutenant with Brazilian Army . Mr. Franco has a non-compensated relationship as a Member with Abraces - Brazilian Association for Cluster Headache and Migraine. that is relevant to AAN interests or activities.

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