Is the Newest Migraine Prevention Drug Right for You?

A headache specialist weighs in

Is the Newest Migraine Prevention Drug Right for You?

If you have frequent migraine headaches — occurring a few days a month or more — you know the toll they can take on your work and quality of life.

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So how much of a difference might the new migraine-prevention drug erenumab (AimovigTM), approved by the Food and Drug Administration in May, make for you?

“This is the first drug specifically developed for migraine prevention,” says Zubair Ahmed, MD, a Cleveland Clinic neurologist specializing in headaches. “In general, that means those taking it will have fewer side effects — and, for some people, it will be more effective.”

How does it work?

Until now, Dr. Ahmed explains, drugs used to prevent migraines were actually designed to lower blood pressure, prevent seizures or treat depression. But they were discovered to also help with migraines, so the drugs were prescribed in what’s called an “off-label” use.

Erenumab is the first in a new class of medications — known as CGRP inhibitors — that address migraines “head-on.”

CGRP stands for the scientific name of a protein that’s naturally found in the nervous system. The protein is released from nerve endings, including those surrounding the brain, where it widens blood vessels and may promote inflammation and pain. The new drug acts by blocking the protein, preventing or reducing pain in the process.

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How effective is it?

In clinical studies, erenumab was associated with an average reduction of one to two headache days per month in people with frequent migraines.

Although that seems pretty modest, it’s about the same benefit gained with the drugs traditionally used to prevent migraines. And the word average is key: Some people had much better results.

“For some patients, erenumab worked extremely well, even eliminating headaches altogether,” says Dr. Ahmed, who’s been involved with studies of other migraine drugs in the CGRP inhibitor class. “And some people who ‘failed’ standard therapies in the past did well with erenumab.”

Several other CGRP inhibitor drugs are under development for migraine prevention and may be approved for use soon. They’ve shown similar effects on migraine frequency in studies to date, Dr. Ahmed says.

How is it taken?

Erenumab is taken once a month by injection. A simple EpiPen®-like injector device makes it easy to self-administer the drug.

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What about side effects?

Side effects in studies of this and other CGRP inhibitor drugs have been mostly minor and mild, mainly skin irritation at the injection site, constipation and upper respiratory tract infections.

But Dr. Ahmed cautions that studies last about six months, while many people need to take migraine prevention drugs for decades.

“Long-term safety data is not yet available for these new drugs,” he says. “It will be important to see if any problems emerge when many more people are using them for long periods of time.”

Other key considerations

Dr. Ahmed adds that a few other issues are crucial to determining with your doctor whether erenumab might make sense for you:

  • Cost. Erenumab has a steep price tag of about $575 per dose. That’s $6,900 a year. But Dr. Ahmed expects that insurance companies will come to an agreement with the drug’s manufacturer to cover erenumab at a more affordable price.
  • Pregnancy. Little data is available on erenumab’s use during pregnancy. To be on the safe side, Dr. Ahmed advises women who are pregnant or planning a pregnancy to wait to use erenumab until more is known.
  • How good is your current therapy? Ahmed tells his patients who are already doing well on a different migraine drug that there’s no reason to switch. “But if you suffer side effects from your current migraine medication or continue having frequent migraines, erenumab is worth a try,” he says.

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