A 35-year-old female with chronic migraine (> 15 headache days/month) has failed topiramate and amitriptyline due to side effects. She is now on overusing triptans. What is the current evidence for anti-CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab) in chronic migraine? When do we consider gepants (rimegepant, atogepant) as preventives? Are there cardiovascular contraindications specific to CGRP pathway drugs?
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