Introduction to the Newest Migraine Medications

There haven’t been any drugs with an FDA indication for migraine prevention within the thousands of medications floating around in the market. Recently, four injectable medications hit the market with good clinical evidence for preventing migraines. In this article, I will introduce these medications and go over some side effects and counseling points.

Biologics

This class of drugs is considered biologics, meaning that they are products made from living organisms. More examples of products made from living organisms include vaccines, insulin, monoclonal antibodies, and pig-derived thyroid supplements. All of these were made from parts of living things to treat a disease state.

In this case, the drugs we’re talking about today are considered monoclonal antibodies. Monoclonal antibodies are manufactured antibodies that resemble the ones people make in their bodies. Sometimes they are fully human antibodies, and other times they are chimeric. This means that part of the antibody comes from another living source, like a mouse, for example.

Monoclonal Antibodies are programmed to attack a certain target in the body, which helps treat diseases such as migraines. The migraine medications all target a peptide called CGRP (calcitonin gene-related peptide).

CGRP plays an important role in migraines by being a potent vasodilator in the brain and causing inflammation. Widening the blood vessels in the brain plus the release of inflammatory markers ultimately cause the migraine. The migraine medications just released are targeting CGRP to prevent dilation and inflammation.

Aimovig

Aimovig (erenumab-aooe) is a monthly subcutaneous1 injection for the prevention of migraines. The recommended dosing for this medication is 70 mg monthly, but select patients can benefit from 140 mg monthly. Aimovig has no clinical benefit over the other medications, so choosing this for migraines is the appropriate initial therapy.

The most common side effects of Aimovig are constipation and high blood pressure. Aimovig does have a coupon card for those with expensive co-pays from their insurance. Patients can access the Aimovig coupon card with the link here.

Important Administration Directions:

• Allow the medication to sit at room temperature and away from direct sunlight for at least 30 minutes. This allows for minimal discomfort while injecting the product.
• Do not shake the injection.
• Make sure to inspect the medication for any discoloration or solid matter. Do not administer the medication if any of those things are present.
• Good places to administer Aimovig are the abdomen, thigh, or upper arm. Do not inject in a place where the skin is broken, bruised, or red.
• The product will deliver a single dose and the entire contents.

Ajovy

Ajovy (fremanezumab-vfrm) is a monthly or quarterly subcutaneous injection for the prevention of migraines. The most common dosings for Ajovy are 225 mg monthly or 675 mg every 3 months. Ajovy also can be chosen as initial therapy for migraine prevention. The most common side effects observed with Ajovy are injection-site reactions. Store the medication in the refrigerator and follow the administration directions from above with Aimovig. Ajovy also has a savings coupon card that patients can access here.

Emgality

Emgality (galcanezumab-gnlm) is a monthly subcutaneous injection for the prevention of migraines. The dosing for this medication for migraines is a loading dose of two 120 mg injections, then one 120 mg injection monthly. Emgality is also a choice for initial migraine prevention therapy. In clinical studies, injection-site reactions were the prominent side effects of Emgality. The medication has the same administration directions as Aimovig and referencing them as you prepare Emgality is appropriate. In addition to migraine prevention, Emgality is also indicated for cluster headaches. The coupon card for Emgality is here for patients with expensive insurance co-pays.

Vyepti

Vyepti (eptinezumab-jjmr) is a quarterly intravenous infusion indicated for migraine prevention. In the hospital setting, the dosing for Vyepti is 100 mg infused over 30 minutes every 3 months. If that dose is insufficient, doubling the dose (300 mg) may get a therapeutic response. A patient or prescriber can choose Vyepti as the first option for migraine prevention. In terms of side effects, the most common observed were nasopharyngitis and hypersensitivity. Vyepti also has a co-pay and savings program here for patients with expensive co-pays.

Footnotes:

1. under the skin