How to Choose the Best CGRP Injectable for YOUR Migraines
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- čas přidán 5. 01. 2020
- How to Choose the Best CGRP Injectable for YOUR Migraines
In this episode of The Headache Channel, Dr. Krob explains how to choose the best CGRP injectable to prevent your migraines.
The CGRP injectable migraine prevention treatments, Aimovig (erenumab), Ajovy (fremanezumab), and Emgality (erenumab) are transforming the lives of people living with migraine by dramatically reducing the frequency of migraine attacks by 50, 75 or even 100 percent.
Migraine prevention is the most important thing you can do if you have migraine. You should consider migraine prevention if you have 4 or more days of migraine (not attacks of migraine - a migraine attack can last 1 or more days) a month. You should commit to migraine prevention if you have 2 or more days a month where you missing work or school, or leaving early, because of a migraine attack. Other reasons to prevent migraines include:
- Going to the ED, Urgent Care, or your doctor's office for a migraine emergency.
- Acute migraine treatments cause awful side effects or don't work.
- Personal preference.
Until 2018, all migraine prevention treatments were drugs that were invented for other problems and "accidentally" found to be helpful for migraine prevention. These drugs include the platform migraine treatments amitriptyline, topiramate (Topamax), divalproex / valproic acid (Depakote) , and propranolol. These drugs are still good basic choices for prevention. But, they may not work well enough for some people, and they can have a lot of side effects and unwanted interactions with other medicines.
The CGRP injectables have changed the picture of migraine prevention. Aimovig, Ajovy and Emgality are injectable monoclonal antibodies. Their mechanism of action is to prevent CGRP from sticking to CGRP receptors. This stops the nervous system's "migraine amplification circuit", the trigeminovascular pathway.
Aimovig, Ajovy and Emgality have a lot in common. They are all injections into the skin with a fairly small needle. The injection sites and techniques are similar. They all can be taken once a month. They all need refrigeration. They all seem to work both quickly and well. They all share two common, and common-sense side effects. They all have no interactions with other drugs.
Because these three treatments have never been tested against each other, no one can really say which one is best. (And I have seen cases where people have not responded to one, but have responded to another.)
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I am on emgality. I cannot believe how much my life has changed in the last year. I had a migraine every day sometimes I would get a good day but usually not. I was living everyday doing normal things with them because I had no choice. I didn’t realize the roll it took on my body until I began emgality, i get maybe one migraine a month now, there has been a month or two where I didn’t even have. I was taking sumatriptan like you would not believe and I don’t need it anymore :) the emgality pen is unbelievably painful to inject, but worth it. Thank you for this info :)
Is it still working for you
I just started my Emgality Pen today (5-28-2023 Sunday). I’m so looking forward to feeling better. I’ve struggled with headaches my whole life, I’ve had a headache going on 4 weeks now!!
@@victoriapitcock6602 you might need a month or two (two injections) to start feeling the effects. That’s what other people have said but for me it was fairly quick, weeks. Goodluck I hope this works for you!
@@joespilsbury2173 yes very well
I have recently switched from the auto injection pen to the self injector syringe and needle and it is much much better. The rate of speed which the medicine is administered with the auto pen is what causes the pain. I miss doses often, even during missed doses my migraines are almost completely controlled after having year(s) of medication in my system.
Not that we get to chose our medication, the insurance company does.
You’re a Saint ! Thank you for making this video available 💛
Awesome info, thank you for taking extra time to provide this service to the migraine community. You rock Dr. Krob!
Great work, thank you
Great video!! Thanks for being so clear and explaining in layman’s terms!
Thank you so much for all of the helpful information! Your'e the best Dr. Krob!
Actually Botox was originally called Oculinum and was used for ocular dystonia in 1978. It was then used for neurological conditions such as blepharospasm and cervical dystonia. It was first used for cosmetic purposes in 1992.
Very helpful. Thanks doctor!
Great presentation. Thank you.
Outstanding presentation
Great channel! Thank you for all the helpful advice!
Art of Makeup School, thank you! 😁
God bless doctor and scientists.
Really good advice!
Thanks, Bruce!
I started having migraines in 1996 up until 2015. I changed my eating habits eg cut off dairy products and all meat except for seafood. This seemed to help for 7 seven years after that until I was diagnosed with covid in april 2022 when the headaches returned. Only this time around Ive been waking up with them more often as a posed to throughout the day and in the past. Presently I am seeking ways to eradicate the headaches again however in the meantime Ive been taking relpax pills which gives me relief once I catch the migraine at the onset taking 1 pill which normally takes about 20 to 30 mins to kick in. Otherwise it take much longer if I allow the headache to progress to the full on stage. Just hearing about this periodic infusion that I'm willing to try. Hope it works!
Nonetheless just sharing this info with you for you to know that you are not alone. I feel your pain, literally! Who feels it knows. Stay encouraged and I hope with all my heart you all find that much needed and desired permanent relief. Take care.
Thank you for sharing this information! I started my inyección today I hope a change in my life( migraine almost every day) 🤕
I think a lot of us would like to know how you are doing.
Well, at this moment my life has changed you know how? With a healthy diet, NO CAFFEINE Any more, no sugar, no bread, no pasta, no corn, I only drink water, plus, no more inyección! I’m not good 100% but 70%. And believe me that’s enough!
@@jocko1283 No I would not... sorry, i recommend No caffeine and a healthy diet, low carbs, I don't recommend Topamax either, that's terrible,
Ajovy worked for me when nothing else has other than morphine. But with no side effects
None of them worked for me beyond a week. Time to try Quilipta.
What about chronic, at least 4 times a week? I've had Aimovig and it did help for a couple to 3 months. Ajovy didn't help. I've been on Topamax and Depakote for years! I loved my job but had to quit. My next step is an appointment with a specialist. I'm looking for someone that does nerve ablation. I'm looking into the Reed procedure.
Hi Doctor! I live in Portland! I have had chronic migraines for years following a brain injury. I have several other brain injury induced disabilities, and I'm now on Medicare/Medicaid with care Oregon advantage. All of the other meds have stopped working. I'm just recovering from a 3 day 10 + migraine, which always leaves me bedridden and depressed. Do you take Medicare/medicaid? If not, I can ask my doctor about one of the injections, plus I want to add Nurtec for breakthrough pain. If possible I would do better with one of the injectable that doesn't cause constipation. Do you happen to know if care Oregon advantage covers any of the injectable and/or Nurtec? I just threw up my antinasau med and the sumatriptan on day 1 of my flare and the rizatriptan didn't work at all last night. I was feeling close to giving up when I remembered a commercial for one of the injectable. I lost EVERYTHING with my young onset, hypoxic-ischemic brain damage induced dystonia and Parkinsoism at age 30 and developed and unrelated corneal disease 3 years ago. I could perhaps push through a little longer without my chronic migraines. I have 1-3 severe migraines/wk and milder headaches throughout the month. I'm in hell. Thanks!
Hello, Dr.Sir. Can now it be said which one is the best or better one? Since Ur video is 3yr old. ThanX in anticipation
I've taken ajovy for a year. I never had frequent migraines until I began working on a computer for 10hrs a day. Screens and leds are triggers for me. When I began work I was up to 1 migraine a week causing me to leave work for the day. On ajovy I had 2 migraines in a year...I have noticed my hand sensitivity to cold is slightly increased. I've always gotten cold fingers slightly easier than other people but living in a colder climate u just get used to it. While on ajovy my fingers become white easier and stay cold much longer. I did hear of one case where a person with raynuads had a troublesome situation while on ajovy. Im guessing the cgrp's interact with vasodilation/constriction in some way?
I think the medical professionals are ignorant of the reality that many chronic/intractable migraines patients have chronic PTSD.
Do you prescibe these for IIH? I've topped out on topamax and my doc wants me to try one, i don't know which to try and I'm skeptical if it will help.
I'm trying this soon. I hope it works. I've had mixed severe headaches that was intensely triggered by a jaw and tooth infection. I've never had a headache in my life before this. I've tried literally everything. This has been going on for a year now. When I had the infections I started getting small migranes at night but I would ignore it and sleep more plus eat healthy. Then one day it hit me like a gun shot in the middle of my kitchen. The pin was so strong I could barely walk or speak. After treating the infections it never went away but it is Inconsistently tolerable for things like store trips or showers. But it still leaves me unable to live my life. I'm hoping to find someone will to investigate my situation more or at least explain why things happened the way they did if they think they know. Because so far nobody has fully done so.
Did try let know how feel please I got migraine over 7 years i wanna try this injection
Topamax made mine insanely worse omg. That one was bad
I have heard that from a couple of folks. It's trial and error. Whenever I hear about topiramate making headaches worse, I wonder about low pressure headache.
@@TheHeadacheChannel ajovy has been the first thing to work. I'm on my 3rd dose and 3rd month without a migraine so far thank god
How are you now?
It should be made illegal imho
I have United healthcare and they denied emgality twice... Such a shame
If this happens to you, don't give up. Insurance companies do have steps you have to go through and they have favorite choices among the options. If all else fails, every policy has fine print where you can appeal a decision you don't like. People don't do it often, but of the 3 or so I know of, everyone has won.
Also has anyone reported to you improvement after covid vaccine???? I had ten days headache free after each vaccine, so random, but worth noting imo when you suffer daily from IIH!
I had a break just like that when I got sick with covid
I’m so hesitant on taking any kind of LT injectable Rx ever since a nightmare w/Depo Provera @ 18. I literally asked if there would be an issue w/migraines (coincidentally) & was told that even though common s/sx were increased freq. & severity of headaches, there would not be an issue w/migraines. Boy, we’re they wrong 😑!!! I had the worst migraine of my life w/total blindness in one eye, dark spots and floaters in the other, numbness on one side and slurred speech. FYI I had also told this horrid (and judgmental/rude/condescending) Ob-Gyn. where I was living in MB, SC for the summer that my mother had had a major CVA the previous year at 35 & I had been told not to take any hormonal birth control to be on the safe side-given I’m practically a clone of my mother (the doctors, nurses and staff- even clients where she’s worked for 40y literally nicknamed us the clone family because of the almost identical resemblance of me, my mother, her youngest sister and her daughter, my middle brother and my daughter! Lol 😆! Out of all of us though-my mother and I almost exactly resemble each other and people even mistook us for twins when I was a teen and she was in her 30s.) The Ob-Gyn. insisted this wouldn’t be a concern w/the Depo. When I had that, “migraine” from hell (which I suspect may have been a mild CVA or TIA, TBH), I was forced to drive myself to the hospital, as I was already en route to work when it hit (luckily, I had a friend/co-worker in the car; but she couldn’t drive). After waiting seemingly FOREVER in the waiting room, the ED MD asked me what I normally took for migraine. I was explaining-w/slurred speech, how this wasn’t like any migraine I had ever had; but he dismissed me. LUCKILY the subq Imitrex worked.
That scenario scared the living h3ll out of me (there were many other horrible side effects-but those are irrelevant to the topic of migraines). Given that you were stuck w/the rx floating around in your system for 3-4 mos., I am kinda scared at the idea of taking a Rx again that is LT, in case there are any unpleasant, or even potentially dangerous, side effects. You state there’s NK side effects from the last 2. I will look into those more. I cannot take the 1st DT a latex allergy.
I believe I read that one of them only is showing -1 migraine day, on avg., whilst the other has shown an avg. of -2.5 days/mo.? This doesn’t seem like a significant enough change to make the Rx worthwhile. Other sources were saying there’s - ~30% migraines/mo. That really doesn’t tell me anything w/o knowing the pt.s’ baseline # of migraines/mo. For all I know, the test subjects had an avg. of 3 days/mo.-which would result in -1 day on avg.
I mentioned on a comment on another video that I am seeking an adjunct or supplemental Rx/tx DT reduced/inconsistent efficacy of sumatriptan nasal inhaler after having excellent/consistent results w/the subq for 22y... but insurances refuse to cover the subq now because the price rose to a ridiculous amt./injection. The freq. of my migraines has increased as well (yes, I am doing many complementary stress reduction techniques to try to offset the issue.) Some of that may be DT hormonal changes, as I’m likely going to go into peri-menopause too. I did see on another comment that sumatriptan isn’t recommended after 50? I had never heard of this and will look into that as well.
I’ve said to multiple PCPs over the last decade that perhaps I should see a neurologist for my migraines-especially when they suddenly increased in frequency and severity 10y ago. They waned down since & have ramped up again. I’m relatively certain there’s a correlation w/extreme acute stress on top of chronic and hx stress. Interestingly, I was concerned about the r/o Seratonin Syndrome 10y ago when I had started taking Prozac again for recurrent MDD that had returned w/the extreme life stress at that time. I was also poo-pood about this. In the past I had fewer migraines while on Prozac and I believed perhaps some of my migraines were thus a result of reduced avail. serotonin in my sys. Never was I ever told by a PCP there was any r/o taking both concurrently. When I became concerned, after being informed about serotonin syndrome working in a medical school, I was told it wasn’t a concern. I take a NDRI now, rather than a SSRI, which is probably less of a concern for this potentially dangerous side effect.
Thank you for this information though. I’m trying to figure out if my insurance will cover an alternative medication to supplement if/when my monthly allotment of sumatriptan nasal spray has been depleted (I actually found out I can receive 10/mo. That doesn’t help or even make logical sense, as the boxes are packs of 6.) I’m considering one of these newer preventatives, or the acute Rx of the same class, or an alt.newer triptan, or even seeing if the insurance will cover an alt. formulation (like the combo nsaid or the 1 w/nasal powder). Unfortunately, I cannot take pills, as I will immediately vomit them back up. This limits the medications or formulations avail. to me.
Whichever the insurance puts you on because these things are $1000 a month WITH insurance.