Employee & Community Health

Taking a closer look at new migraine medications

10/24/2019 by Linda Huang, PharmD

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Migraines affect 29.5 million Americans. They're highly disabling and reduce quality of life. Chronic migraines, defined as 15 or more attacks per month, occur in around 10% of patients who have migraines. 

You may have seen commercials for several new migraine prevention medications. In 2018, Ajovy® (fremanezumsab-vfrm), Emgality® (galcanezumab-gnlm) and Aimovig® (erenumab-aooe) were approved for migraine prevention in adults. 

Ajovy, Emgality and Aimovig are monoclonal antibodies. This means they're lab-developed proteins that target specific substances in the human body. In this case, they block the calcitonin gene-related peptide (CGRP), a protein in the nervous system associated with the inflammation and pain of a migraine attack. 

Currently, CGRP blockers are expensive and have insurance coverage limitations. You may be a good candidate for these medications if: 

  • Diagnosed with chronic migraines or have frequent, severe migraines that require migraine prevention
  • Have tried and failed at least two migraine-prevention medications from different pharmacologic classes

There's limited information on side effects and use in certain populations. Talk to your doctor or pharmacist about whether CGRP blockers are appropriate if you are: 

  • Using Botox (onabotulinumtoxin A)
  • Pregnant or breastfeeding
  • History of heart disease or stroke
  • Immunosuppressed

In trials, CGRP blockers decreased the number of migraines per month. It may take up to three months to see improvement in the frequency of your migraines. All three CGRP blockers come as monthly injections. Although generally well tolerated, there are reports of injection-site reactions, fatigue and constipation. 

Linda Huang, PharmD, is a pharmacy resident in ambulatory care. She will be in training at several different Employee and Community Health (ECH) sites, including Mayo Family Clinic Kasson and the Anticoagulation Clinic.