There have not been many new advances in migraine treatment until recently. The triptans, starting with sumatriptan (Imitrex), were the last so-called breakthroughs against migraines. That was 30 years ago. Now, a new class of migraine medicines has been launched starting with Aimovig, an injectable monoclonal antibody. Is it worth almost $9,000 a year?
How Effective is Aimovig Against Migraines?
Q. You recently had a question from a pharmacist whose sister developed ulcers taking Excedrin Migraine for her headaches. She should consider using the new FDA approved injectable called Aimovig. This is a medicine to prevent migraines.
I just had my fifth dose yesterday and my migraines have improved greatly. The only real side effect is constipation, which can be managed with Miralax.
I have also been using Botox every three months along with trigger point injections and nerve blocks for the past couple of years. I take almotriptan for the migraines I do get now, but they aren’t as bad as they were by a long shot since taking the Aimovig.
My heart breaks for anyone who suffers with debilitating migraines–they are the worst thing I’ve had to deal with.
Aimovig Is an Advance but Is It a Breakthrough?
A. Erenumab (Aimovig) is an important new advance for migraine prevention. The FDA approved it earlier this year. Two similar drugs were approved even more recently: fremanezumab (Ajovy) and galcanezumab (Emgality). These are all injections that patients administer themselves to prevent recurrent migraine headaches.
This person is a fan of Ajovy:
Q. My migraines started in perimenopause and then ramped up until I was suffering more than half the month. I have tried so, so many things, among them hormone replacement therapy, supplements, rescue medications, exercise, acupuncture, massage, Botox and major dietary changes.
What has helped me the most is Ajovy, but not right away. It took a full four months before I really learned how to self-inject properly and that has made a difference.
A. Ajovy (fremanezumab) belongs to a category of migraine prevention medicines called CGRP antagonists. Other drugs in this class include Aimovig (erenumab) and Emgality (galcanezumab).
We’re glad you have gotten relief. The clinical trial for Ajovy demonstrated that people using this monthly injection had about two fewer migraines a month compared to placebo. These volunteers averaged about 13 “moderate severity” migraines a month prior to treatment. If insurance does not cover these monthly injections, the cost could be nearly $800 a month.
How Many People Suffer from Migraines?
The CDC keeps track of headache statistics (March 27, 2020). The National Health Interview Survey revealed:
“In 2018, women were nearly twice as likely as men to have had a severe headache or migraine in the past 3 months (20.1% versus 10.6%), both overall and within each age group. The percentage of persons experiencing severe headache or migraine declined with age for both men and women, from 25.5% among those aged 18–44 years to 7.6% among those aged ≥75 years for women and from 12.3% among those aged 18–44 years to 4.0% among those aged ≥75 years for men.”
An article in Headache, The Journal of Head and Face Pain (March 12, 2018):
“Recurrent headache disorders such as migraine are leading causes of suffering and disability at the national and global level. Unlike many other chronic diseases, the morbidity attributable to these disorders is largely concentrated in otherwise healthy young and middle‐aged people, particularly women.”
Is Aimovig Worth $9,000 a year?
In theory, insurance companies should pay for Aimovig. They may require patients to have tried other migraine medicines first. If the other treatments are not helpful, then Aimovig may be approved.
It has been estimated that one out of six people benefit from this injectable migraine medicine (Forbes, June 6, 2018).
Here is another way to view the drug’s effectiveness. People who suffered with chronic migraines were randomized to receive either monthly Aimovig injections or placebo injections. Those getting the true migraine medicine had 6.6 fewer “monthly migraine days” or MMDs. Those getting placebo had 4.2 fewer monthly migraine days. So the pricey injection reduced the number of MMDs each month by about 2.5 days. That’s not nothing, but it might not qualify for breakthrough status.
Aimovig Side Effects:
In general we would have to say that this migraine medicine is less likely to cause adverse drug reactions than many other drugs, especially triptans. People complain about injection site reactions, constipation and muscle cramps or spasms.
Another Reader, Cindy in Fort Worth, Texas, shares this story about her daughter:
“My 18-year-old daughter suffers from almost continuous headaches that never go below a pain lever 5. We are taking her to college and are terrified. We’ve gotten her a single room to help her manage her exposure to triggers and to have a refuge when she needs to shut down.
“We’ve been though three classes of drugs and she continues on verapamil extended release with little real relief. Botox was not effective.
“We tried 3 sphenocath treatments that also had no impact. She uses Migrarelief and we’ve tried the Cephaly. The onset of the migraines followed a concussion, although she says her daily headaches predate the concussion.
“She eats as gluten free as much as possible which seems to lessen the intensity. She’s going to school near Houston so we plan to transition to an adult doctor there. Pain clinic? Neurologist? New med trial?”
Readers have attempted to help Cindy:
Nat in Houston, Texas, shared this recommendation:
“For the posters in the Houston Tx area, I recommend Dr. Loftus at Bellaire Neurology. He is a headache specialist who helped me a lot with effective treatments.
“Migraine sufferers should also know that a new drug (Aimovig) has been released that is probably the biggest improvement in migraine treatment in decades because of its limited side effects.”
Donna in Denver, Colorado, added this:
“Cindy, I do feel your pain. My son started to have migraines when he was thirteen. It has been a life struggle to figure out how to help him.
“I feel the anger of why our medical system has only come up with drugs to “try to treat the symptoms” instead of finding the cause. It is obvious to me it has a lot to do with hormones. But what can a doctor do about it?
“All my son can do is to try to avoid his triggers- dehydration, not eating before bedtime and STRESS. He is 31 years years old now and has had less migraines as he has become older.
“I would suggest having her go to an OB/GYN who specializes in hormones.”
Terry recommended one other thing:
“Cindy, has she been tested for celiac disease? It isn’t the first suspicion, but sometimes that is how celiac disease presents.”
More About Aimovig and Other Migraine Options:
We had the opportunity to interview Jennifer S. Kriegler, MD, in August, 2018. She is director of the Headache Medicine Fellowship at the Cleveland Clinic. Dr. Kriegler is part of the Center for Neurological Restoration and the Headache Section of the Neurological Institute in the Department of Neurology of the Cleveland Clinic. She helped run some of the research on Aimovig. Our one-hour interview with Dr. Kriegler can be found at this link. She also offers many other options for dealing with chronic headaches.