II. Indications

  1. Migraine Prophylaxis if refractory to first-line agents

III. Mechanism

  1. CGRP Antagonists block CGRP activity (vasodilator)
  2. Calcitonin Gene-Related Peptide (CGRP) levels increases at Migraine Headache onset
    1. Vasodilator
    2. Pain sensitizer

IV. Preparations

  1. Erenumab (Aimovig) autoinjector
    1. Inject SQ once monthly in Abdomen, thigh, upper arm
  2. Ajovy (Fremanezumab)
    1. Three injections from prefilled syringes once every 3 months
  3. Emgality (Galcanezumab)
    1. Once monthly injection via pen

V. Adverse Effects

  1. Injection site mild reactions

VI. Efficacy

  1. Reduces migraine Incidence by 2 fewer Migraine days/month

VII. Disadvantages

  1. Limited safety data outside healthy patients without comorbidity at time of 2018 release
  2. Expensive: $6900 per year

VIII. References

  1. (2018) Presc Lett 25(8)
  2. (2018) Presc Lett 25(12): 70

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