Abstract
Migraine is a prevalent chronic neurological disorder associated with significant disability and an increased risk of cardiovascular diseases, particularly ischemic stroke and myocardial infarction. Calcitonin gene-related peptide (CGRP), a key mediator of migraine pathophysiology, plays an important role in pain transmission and vascular regulation and exhibits potent vasodilatory and potentially cardioprotective effects. Gepants, small-molecule CGRP receptor antagonists, have emerged as an effective treatment for acute migraine attacks and prevention. Unlike triptans, they do not induce vasoconstriction, making them a promising therapeutic option for patients with cardiovascular contraindications. However, inhibition of the CGRP pathway may raise concerns regarding potential cardiovascular effects, particularly in patients with pre-existing cardiovascular disease. This review aims to evaluate the available evidence on the cardiovascular safety of gepants, with particular emphasis on their use in patients with cardiovascular comorbidities and risk factors.