38-year-old male presents with intractable headaches
History of present illness: A 38-year-old male in excellent physical condition presents with a five-year history of intractable headaches, occurring with increasing frequency, which are suspected of being cluster headaches. He notes his headaches are always worst in the fall or spring, and that they "knock him out" for a few days. Medical imaging studies and bloodwork have been done to rule out any other conditions. He denies feeling anxious or particularly stressed out, but he does note feeling very sluggish since starting topiramate six months ago. He has heard about anti-CGRPs and wants to learn more about them.
Social history: Patient denies tobacco, alcohol and ilicit drug use. He lives with his wife and their two children. He runs his own business online. He is an avid runner and extremely health conscious. He reports that he became so given that when he was a kid, his father had to have a cardiac bypass procedure, and that his mother had high blood pressure and hyperlipidemia.
Medication: Imitrex as needed. Topiramate daily, taken before bed. Fexofenadine as needed.
Past medical history: Nothing of note.
1. What would you tell this patient about anti-CGRP medications?
2. What concerns (if any) would you have about this patient's family history and his condition?