CGRP (calcitonin-gene-related peptide) when released causes intense inflammation in the coverings of the brain (the meninges), and for most migraine patients, causes the pain of a migraine attack. This peptide dilates blood vessels which causes several pain processes, most notably migraine headache.
Mechanism: drug therapy is directed against calcitonin gene related peptide (CGRP) or its receptor to prevent migraine and cluster headache.
Aimovig (erenumab-aooe) 70mg ——
Injections are given once a month
Side effects: injection site reaction and constipation. Constipation may be significant, best to avoid in patients already suffering from constipation, or taking constipation inducing meds (TCA’s, opioids)
Storage: Store under refrigeration. Allow to come to room temperature for 30 minutes before administration
Ajovy (fremanezumab-vfrm) —-cost $600.00 per month. Approved Sept-2018
Recommended dosage for migraine prevention is one dose once a month or 3 injections given at one time every 3 months. : Two subcutaneous dosing options of AJOVY are available to administer the recommended dosage:
Storage: Remove AJOVY from the refrigerator. Prior to use, allow AJOVY to sit at room temperature for 30 minutes protected from direct sunlight.
Emgality has two uses:
- Preventive treatment of migraine
- Treatment of episodic cluster headache
Aimovig, Ajovy, Emgality:
- All three were approved between May and September 2018
- All three cost the same $725.00 per injection. All have copay coupons for commercial insurance.
- All three can be injected in the abdomen, upper thigh, or upper arm. All list injection site reactions as side effects
- Aimovig contains latex, the others are latex-free.
- Only Emgality, thus far is approved for cluster headache treatment. It also is available as an auto-injector (like the Trulicity device)
Vyepti (eptinezumab-jjmr) approved February 2020
Dosing: Vyepti is administered by IV infusion in a health care setting, every 3 months.
Your Thompson Pharmacist says:
As you can imagine these $700 migraine treatments require prior authorization from your physician. Your physician most often can call the insurance company and get approval, usually based on patient history.
Be sure to keep a good migraine headache diary. Keep track of your headache triggers and log in when you get a headache and what you treated it with. Remember to take your migraine prevention medications as prescribed by your physician. More than eight migraine headaches per month indicates that a drug for prevention is needed. Go Ahead and Ask… at Thompson Pharmacy… it’s All for YOU!!