A few years ago I wrote a blog called AIMing for Perfection (see here: https://goingagainstthegraine.home.blog/2020/03/17/aiming-for-perfection/) about how Aimovig, the CGRP inhibitor auto injectable, was significantly reducing my migraine count. I had been on Aimovig for about 5 months (5 doses) when that post was published and doing the best I’d done in over a year. I think it’s time for a follow-up on that post.
I stayed on Aimovig for 8 months, ufortunately having to stop it when it ceased working. I’d begun having more migraines and my NP explained that this can sometimes happen- patients stop responding to the medication. She switched me to Emgality- the third CGRP inhibitor injectable migraine preventative. I tried it for the recommended 4 months but itdidn’t have the wonderful effect that Aimovig had (though it burned like heck).
Before I continue my saga let’s pause to explain CGRP and the medications involving it. CGRP stands for Calcitonin Gene-Related Peptide, a neurpeptide made of 37 amino acid and thought to increase cerebral vasodilaion and inflammation- both factors in migraine pathophysiology. CGRP monoclonal antibodies such as inhibitors like Ajovy and Emgality block the peptide from its activity, hypothetically reducing migraine. CGRP antagonists (such as the oral tablets Nurtec and Ubrelvy) work similarly to stop migraines once they’ve begun. This class of drug is the first to have been developed solely for the treatment of migraine. Until they were approved, headache specialists were only able to prescribe other classes of medication (e.g. antiarrythmics, antiepileptics) created for other conditions that seemed to work for some headache patients. The CGRP inhibitors and antagonists are entertainingly identifiable by their “gepant” ending; rimegepant, atogepant etc.
While Aimovig, Ajovy, and Emgality are monthly injectibles, Vyepti is a CGRP inhibitor that is administered every three months via IV infusion at a dose of either 100mg or 300mg. I began Vyepti earlier this year when Emgality failed, at the starting dose of 100mg. The first treatment seemed to help, but subsequent infusions didn’t offer much relief. It is a challenging trial and error, as a patient has to wait 3 months between doses and try 3 doses to see if it is effective. I have an infusion this month and am increasing to 300mg. If that doesn’t work we will move on to the next option.
For some, CGRP inhibitors and antagonists are a godsend- a monthly shot in the stomach or thigh that saves them from a world of pain. For others, it is just another drop in the bucket of tried and failed treatments. Everyones migraines are different and respond differently to each medication. Here’s hoping 300mg is the answer! In the meantime I am also seeing a new headache specialist closer to home at Hackensack University Hospital in hopes that he might have some fresh ideas, or at the very least save me a drive to Philly.
Today’s Tip:
- If one CGRP inhibitor doesn’t work for you, try another! Though they are in the same class of drug, they have small differences in their function and some patients respond better to one over the other!
Have a healthy productive week!
Sources:
Going Against the 'Graine 
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