How to Choose the Best CGRP Injectable for YOUR Migraines

How to Choose the Best CGRP Injectable for YOUR Migraines

In this episode of The Headache Channel, Dr. Krob explains how to choose the best CGRP injectable to prevent your migraines.

The CGRP injectable migraine prevention treatments, Aimovig (erenumab), Ajovy (fremanezumab), and Emgality (erenumab) are transforming the lives of people living with migraine by dramatically reducing the frequency of migraine attacks by 50, 75 or even 100 percent.

Migraine prevention is the most important thing you can do if you have migraine. You should consider migraine prevention if you have 4 or more days of migraine (not attacks of migraine - a migraine attack can last 1 or more days) a month. You should commit to migraine prevention if you have 2 or more days a month where you missing work or school, or leaving early, because of a migraine attack. Other reasons to prevent migraines include:

- Going to the ED, Urgent Care, or your doctor's office for a migraine emergency.
- Acute migraine treatments cause awful side effects or don't work.
- Personal preference.

Until 2018, all migraine prevention treatments were drugs that were invented for other problems and "accidentally" found to be helpful for migraine prevention. These drugs include the platform migraine treatments amitriptyline, topiramate (Topamax), divalproex / valproic acid (Depakote) , and propranolol. These drugs are still good basic choices for prevention. But, they may not work well enough for some people, and they can have a lot of side effects and unwanted interactions with other medicines.

The CGRP injectables have changed the picture of migraine prevention. Aimovig, Ajovy and Emgality are injectable monoclonal antibodies. Their mechanism of action is to prevent CGRP from sticking to CGRP receptors. This stops the nervous system's "migraine amplification circuit", the trigeminovascular pathway.

Aimovig, Ajovy and Emgality have a lot in common. They are all injections into the skin with a fairly small needle. The injection sites and techniques are similar. They all can be taken once a month. They all need refrigeration. They all seem to work both quickly and well. They all share two common, and common-sense side effects. They all have no interactions with other drugs.

Because these three treatments have never been tested against each other, no one can really say which one is best. (And I have seen cases where people have not responded to one, but have responded to another.)

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