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This is a new class of migraine specific treatment used as a preventative treatment in migraine. This is injected once a month. Calcitonin gene-related peptide (CGRP) is an important chemical found in nerve cells and involved in the transmission of pain signals. Studies have demonstrated that during a migraine attack there is an increase release of CGRP. Anti-CGRP drugs are ones which stop the action of CGRP. They are licensed as a treatment for patients with migraine. There are 4 classes, one binds to the receptor (Erenumab/Aimovig) and the rest to the protein itself (Fremanezumab/Ajovy; Galcanezumab/Emgality; Eptinezumab/Vyepti). There are a few treatments which have been approved but the FDA but are yet to be available here in the UK. These include Qulipta (Atogepant) which can be used as a preventative and Ubrelvy (Ubrogepant) and Nurtec (Rimegepant) which can be taken as acute treatment.
Before Treatment
No migraine treatment which will work for everyone. 50-60% of people who try them will find them beneficial. Before recommending treatment, your doctor will have checked that it is a suitable treatment for you and will discuss with you what the treatment involves and what you can expect. You may be asked to continue with your migraine diary. Once the decision is made that you are suitable for CGRP mAbs, you will be provided with link to a video demonstration outlining how the injections are given and stored. Injection sites may include the abdomen, thigh or upper arm. You will have 3 injections, to be given once a month. Following this you will receive an appointment with your headache specialist to discuss the outcome based on your headache diary and the headache disability scores. If found beneficial you will receive further injections and review again at 6 months, 12 months and then annually.
Further Information
They can be used in episodic and chronic migraines. They cannot be used during pregnancy or breastfeeding and it is recommended that they are stopped 5-6 months before trying to conceive. Main restrictions include cardiac disease, uncontrolled blood pressure, previous clots in the lungs/legs and strokes. Caution is advised in those with a history of raynaud’s and peripheral vascular disease. The commonest side effects include constipation’s, rash, hair loss, and respiratory tract infections.. Temporary elevation in blood pressure has also been identified in studies. It is possible to change from one Mab to another if it is not working or you are experiencing side effects. It is generally recommended ed to have a washout period of 3-6 months before trying another one.
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