Ask Dr. Molly

What is the difference between Aimovig, Ajovy, and Emgality for migraine prevention?

All three drugs are part of a category called CGRP monoclonal antibodies and represent the first migraine specific preventive category to come to the US market.  All show good efficacy and tolerability in clinical trials. All are only for adults 18 and over. None have been studied for safety in pregnancy & breast-feeding. Aimovig targets the CGRP receptor and both Ajovy & Emgality target the CGRP ligand to prevent migraine. The main difference is in dosing and administration. Aimovig is given as either a 70 or 140 mg monthly subcutaneous injection and comes as an auto-injector. Ajovy is dosed as 225 mg monthly or 675 mg quarterly subcutaneous injection and comes as a prefilled syringe with a small needle. Emgality is given as a loading dose of 2 injections of 120 mg each then a monthly 120 mg dose. Like Aimovig, Emgality comes as an auto-injector. All three are designed for self-injection at home. Aimovig and Ajovy can be injected in the thigh, abdomen, or upper arm. Emgality has an additional injection site of the buttocks. All three should be disposed of in a Sharps Container. Lastly, all three can be injected as part of an office visit if you feel you are a candidate.

To make an appointment, please call 949-861-8717.

I have cluster headaches. Would any of the new CGRP monoclonal antibodies (CGRP mABs) work for cluster headache prevention?

Currently the only FDA approved indication for the CGRP mAB’s is for migraine prevention in adults. However, studies are underway for cluster headache prevention and the results look promising. In particular, Lilly recently completed a cluster headache trial with Emgality. For more details, go to https://migraineagain.com/emgality-cluster-migraine/ Non-CGRP treatment options include the relatively new GammaCore device. GammaCore is FDA approved for acute cluster headache treatment as well as an adjunctive treatment for cluster prevention. We have the device in our office and can arrange for a demonstration as part of an office visit.

To make an appointment, please call 949-861-8717.

What is CBD and can it help my migraines?

CBD (cannabidiol) is one of several cannabinoids found in marijuana and hemp plants. CBD is not psychoactive and has low abuse potential compared to THC that is psychoactive and can cause someone to get “high”. CBD has been used to treat anxiety, insomnia, headaches, and seizures. It is felt to have anti-inflammatory properties. Typically it is dispensed as oil that can be put under the tongue or can be mixed or infused in a number of ways. Significantly, The FDA approved Epidiolex, a CBD-based drug, to treat certain forms of epileptic seizures. The FDA, National Institutes of Health, and the World Health Organization, all feel more research and testing are needed. In short, CBD may help your migraines but it is not FDA approved for migraine treatment.  For more information, go to www.uspainfoundation.org, www.TheMintLeaf.org, and www.projectCBD.org

To make an appointment, please call 949-861-8717.

Is the new Ajovy for migraine prevention better than Aimovig?

There have not been any studies comparing Ajovy with Aimovig. This new category of CGRP monoclonal antibodies is an incredible break-through for migraine prevention. Experience in the “real world” apart from clinical trials may help us answer your question. Significantly, both Aimovig and Ajovy have favorable side-effect profiles, are well-tolerated, and quite effective (as early as 1 week in some patients) in clinical trials.

Some patients may feel one works better than another just like some patients prefer Sumatriptan to Rizatriptan vs others prefer Rizatriptan to Sumatriptan. Treatment needs to be individualized to each patient. We are here to help develop your individualized migraine treatment plan.

To make an appointment, please call 949-861-8717.

Is there evidence that use of the computer, kindle, and cell phone contribute to migraine? Is the light emitted from these devices troublesome?

Yes, there is evidence that high energy (HEV) blue wave or “blue light” that flickers from our electronic devices can aggravate migraines. This “blue light” can disrupt our sleep patterns at night, can cause eye strain, and cause oxidative stress all of which are associated with migraine.  Treatment includes avoiding use of these devices for 3-4 hours before bedtime, wearing blue light blocking glasses while using these devices, and installing blue light blocking screens.

To make an appointment, please call 949-861-8717.

What Is CGRP?

CGRP stands for Calcitonin Gene-Related Peptide.  It is a neuropeptide located in neurons (nerve cells) and smooth muscle throughout the part of the nervous system that is part of the migraine process. When a migraine trigger occurs in a susceptible individual, CGRP levels increase and this increase is felt to be major part of the pathophysiology of migraine. Research has demonstrated elevated CGRP during migraine attacks. In addition, research has demonstrated relief of a migraine attack when a CGRP blocking medication is given. This blocking of CGRP is the mechanism of action of the new category of CGRP Monoclonal Antibodies that are now coming to market for the prevention of migraine. The first one available, Aimovig, blocks CGRP activity at the receptor site. To learn more, go to www.Aimovig.com and www.scienceofmigraine.com

To find out if this new preventive treatment makes sense for you, please schedule a visit at our office. We are very excited about this new treatment.

To make an appointment, please call 949-861-8717.

How do I know if the new CGRP preventive injection is for me?

The new category of CGRP Monoclonal Antibodies for migraine prevention is ideally suited for anyone suffering from migraine at least 4 days per month. The first one is now available and is called Aimovig. It is approved for adults 18 and over. It is not recommended in women who are breast-feeding or pregnant. Most likely insurance companies will require failure or intolerance of at least 2 standard oral migraine preventives. The best next step would be to come in for an appointment so we can determine if Aimovig would be a good next step for you.

To make an appointment, please call 949-861-8717.

Why shouldn’t I use a narcotic to rescue a severe migraine attack?

Increasing evidence from research shows that narcotics can worsen a headache condition by causing narcotic/opioid hypersensitivity. This means that over a period of time no acute medication will work as well. Narcotics are not migraine specific and are not FDA approved for the treatment of migraine. There are migraine-specific medications, oral and non-oral, that are much more appropriate for the treatment of an acute migraine attack such as the triptan category.

 

To make an appointment, please call 949-861-8717.

Why are my headaches worse in the winter?

There can be many reasons for worsening of a headache pattern during winter months. Weather changes can be a factor, especially drops in barometric pressure that can occur before a storm. Turning heaters on can be a trigger if dust or mold has accumulated in the air ducts. For some, Holiday stress can be a trigger either from travel or entertaining. Also, there is a tendency to fall off your exercise program, not eat as healthy, and not have a consistent sleep schedule during the Holidays. Now that the Holidays are over, resuming a healthy life style should help.

To make an appointment, please call 949-861-8717.

Can a person experience a migraine without pain?

Yes, they are not uncommon.  Typical symptoms include visual symptoms (flashing lights, zig-zag lines, or the absence of vision in all or part of the visual field).  Other symptoms can include tingling on one side of the body and/or slurred speech, or vertigo.  These types of migraines are often referred to as aura without headache (acephalgic migraine).  Symptoms may last from minutes to days.   Treatment varies but may include migraine specific medication.  These symptoms should always be evaluated by a healthcare provider for a correct diagnosis.

To make an appointment, please call 949-861-8717.