- Migraine Prophylaxis if refractory to first-line agents
-
Calcitonin
Gene-Related Peptide (CGRP)
- CGRP is a neuropeptide that acts as a vasodilator and pain sensitization
- CGRP Is released by trigeminal Neurons in Migraine Headache, Cluster Headache and Trigeminal Neuralgia
- CGRP Inhibitors block CalcitoninGene-Related Peptide (CGRP)
- CGRP Monoclonal Antibody agents that are injectable
- Contrast with Gepants which are oral or intranasal agents that block CGRP
- Erenumab (Aimovig) autoinjector
- Inject SQ once monthly in Abdomen, thigh, upper arm
- Ajovy (Fremanezumab)
- Three injections from prefilled syringes once every 3 months
- Emgality (Galcanezumab)
- Once monthly injection via pen
- Injection site mild reactions
- New onset or worsening Hypertension (Erenumab or Aimovig)
- Associated with 60 cases of systolic increase of 40 mmHg, diastolic increase of 30 mmHg
- Occurred within 1 week of first or second dose
- May be related to the blockade of CGRP which is a vasodilator
- Avoid in Uncontrolled Hypertension or significant Cardiovascular Risk
- Incorporate Home Blood Pressure Monitoring for the first few months after starting
- (2021) Presc Lett 28(4): 19-20
- Saely (2021) Headache 61(1):202-8 [PubMed]
- Limited safety data outside healthy patients without comorbidity at time of 2018 release
- Expensive: $6900 per year
- (2018) Presc Lett 25(8)
- (2018) Presc Lett 25(12): 70