man with his head in a vice, stop cluster headaches

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 25 years ago. Now, a new class of migraine medicines has been launched starting with Aimovig, an injectable monoclonal antibody. Is it worth almost $7,000 a year?

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.

How Many People Suffer from Migraines?

The CDC keeps track of headache statistics. The National Health Interview Survey revealed:

“In 2015, 20.0% of women and 9.7% of men aged ≥18 years had a severe headache or migraine in the past 3 months. Overall and for each age group, women aged ≥18 years were more likely than men to have had a severe headache or migraine in the past 3 months.”

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 $7,000 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.

Reader Suggestions:

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.

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  1. Marieke
    Houston
    Reply

    To the reader who recommended R. Loftus in Houston: the good doctor seems to be doing quite well, as he does not accept Medicare patients. That leaves out a very large portion of the population. Can’t wait for some of the European medical system to be transferred here so more fewer Americans have to suffer.

  2. G
    utah
    Reply

    Only $6,900 annually, a bargain for sure. Good health and vitality comes from a bottle prescribed by doctors, bought and paid for by the pharmaceutical industry. I might as well tell the truth as you do not post my posts anyway.

  3. Kathy R.
    CA
    Reply

    Aimovig is wonderful – cutting my migraines in half! I still take topiramate but at a lower dose.

  4. John
    Orlando, FL
    Reply

    I suffer from migraines at least twice a month and have tried every OTC and administered drug. As I read all the comments and thoughts of others I want to share an experience that maybe someone else can benefit from. I was eating bottles of Excedrine Migraine, and although I don’t suffer from any side effects of extensive usage yet, I am worried that I will at some point. Recently, I was on vacation and awoke to a terrible migraine. Nothing was working to rid me of the pain. My mother-in-law suggested Acupuncture. I want to say, it actually worked instantly once they started inserting the tiny needles into my head. I always get my migraine as pressure behind my eyes, forehead, and lower back of neck. I was in the office for less than a half an hour and walked out as if I never had a headache at all. It has been 2 weeks since the office visit, and no headaches or pressure yet. I can’t say this miracle will happen to everyone, but if it can help me there are others that could benefit if they try something out of the normal.

    I was skeptical of alternative medicine, but anything that could help naturally rather than continuing to take pills and await the after effects, I am willing to try now.

    • Marieke
      Houston
      Reply

      Several acupuncturists have tried to work on my migraines. No result, ever. But then, everybody is different.

  5. hank t.
    Reply

    Whenever I feel a migraine coming on, I pick a leaf from the feverfew plants that grow like weeds in my yard/garden. Feverfew always cuts the migraine off short.

    • Marieke
      Houston
      Reply

      I tried that. The first month it worked then, just as with all the other supplements, the migraines returned at their “regular” rate.

  6. Jan
    Dallas
    Reply

    I have had chronic migraines for over 18 years. I have used most of the triptans with varying degrees of success, also, Botox, Cambria, and injectable imitrex.

    I started Aimovig in August. I am prescribed 2 of the self injected shots every month. I also started ketamine infusions. Together I am almost completely free of migraines. I do get random headaches but they rarely rise to the level of a migraine.

  7. WK
    Raleigh
    Reply

    A researcher M.D. I see at Duke prescribed Amovig to treat “neural inflammation” for suspected neural Lyme disease. So far I have been too chicken to try it. I read several complaints online by people who ended up in the ED after reacting to Amovig. I have had an idiosyncratic response to Miralax. After the second time I called the company and asked if anyone had a significant problem with Miralax and was told two people had died from its use. The thought of a similar response to Amovig, a medicine that stays active for weeks in the patient, truly scares me.

  8. Evelyn
    North Carolina
    Reply

    Not much is written about the food and beverage triggers causing migraines. Reading labels and avoiding potential triggers when dining out is not easy but has made a big difference in my life. If there is a sauce or gravy or casserole I stay away. I also avoid anything pickled or fermented (yes, soy sauce, wine, etc.), specific enzymes (pineapple, papaya, cheese, etc.), flavor enhancers (there are many), meat tenderizers (see papaya and pineapple). While chocolate is presumed to be a trigger, it doesn’t affect me so I’m guessing each person may react differently to some triggers.

    Use multilple online sources to compile a complete trigger list, as food intake triggers are a low priority with medical professionals. No one agrees, and you have to compile your own list and then work with it. MDs prefer to prescribe. For many years Cafergot was my only medicine relief but it can have serious side effects and is currently very expensive. What now saves me when I get caught (going to a potluck, etc.) with trigger food ingestion is a Butalbital-based tablet. I have no side effects. and it’s been around for ages. Take it only as needed, which is my preference for almost any drug. If I can adhere to strictly following a regimen of avoidance of trigger foods/beverages, no migraines. Hard to do but definitely worth it.

  9. Dianne
    Memphis, TN
    Reply

    I, too, have been taking the Aimovig for 3 months. It immediately cut way down on how often I had to take Imitrex, so I highly recommend it. I still have headaches but few migraines.

  10. Maggie
    Georgia
    Reply

    I was suffering from severe migraines occurring several times a week and almost ruining my life. I was seeing a neurologist and then a specialist. I could get some relief with Zomig and Maxalt but my insurance started reducing the number of pills they covered each month. I developed another horrible condition and eventually was prescribed Topamax for it. I was so happy when I found that the Topamax also prevents almost all my migraines!!! I take 180mg every day, and sometimes I can go months without a migraine!

    • Marieke
      Houston
      Reply

      Wow! Just to show how different people react to different drugs: a new neurologist prescribed Topomax, I tried it. The doses increased every week, but by week #3 my brain felt like Swiss cheese: I couldn’t add 3+4 without a calculator, I couldn’t concentrate, I couldn’t remember. The doctor said to hang in there, so I did. By week #5 I had a good idea of what Alzheimer’s must feel like. It was more than freaky, and, worst of all, there had been no reduction in the number of migraines. I stopped taking Topomax. It took a few days for my brain to pick up normal functions, but Topomax is probably the scariest drug I have ever taken. I’m glad it works for some people, but never again will I let any neurologist talk me into something that makes me feel that bad.

  11. Cheryl
    Chicago
    Reply

    It is important for people with Migraines to research rebound headaches especially if you are getting a migraine every other day. It is a reaction to the medicine you are taking for the migraine, and the only way to stop the cycle is to stop the medicine. My neurologist did not share this information with me, and I had to find it out on my own. More and more medicine (unless preventative) is not always the answer and can make things worse.

  12. Bird
    Reply

    I have chronic cluster headaches. They have lessened over time, but find I must continue to take Butterbur 4x daily, Robaxin for fibromyalgia, cetirizine, B-complex and so forth. The butterbur is affordable, and I can under no circumstances afford any of the drugs mentioned above. Zomig works well if I catch the headache in time (Thank god for Impax who provides this to me). Following this regime has allowed me to reduce prescription drugs but I still take Exedrin and Anacin daily. In 30 years the only trigger may be alcohol, but I no longer drink. Stress plays a part and 10 mg melatonin nightly helps me sleep well. I switched to Armour Thyroid several years ago. Can’t comment on whether it helps but I feel sooo much better.

  13. Margie
    Florida
    Reply

    This is for Cindy in Ft. Worth, whose daughter is taking Verapamil extended dose. My husband had daily debilitating headaches that nothing helped. He went to the Headache Clinic at USF in Tampa. Dr. there ordered him to take Verapamil generic only, NO Name Brand. His daily dose is 640 mgm in divided dose 3 times a day. Normal daily dose is 480 mg. This has worked like a charm with immediate results. If he misses one dose his HA returns. He has been on this since 1999 and is healthy. Side effects are mainly constipation and swollen ankles. Don’t give up on exploring Verapamil for your dose and type of pill for relief. This is well worth a try.

  14. Kate
    Massachusetts
    Reply

    My husband started getting multiple migraines a month several years ago. Thankfully, he is self-employed or he would have lost his job, as he was only able to work 2 to 4 days a week. Triggers seemed to be changes in the weather and stress. He went to a local pain clinic for Botox injections, which I don’t think helped any, and maybe made things worse. After some research and calling our insurance company to determine if any of the new meds were covered, he asked his doctor about prescribing the covered one, Aimovig. First month, he had 5 headaches instead of 15, and he didn’t need to take a triptan drug for any of them. I suspect, like all meds, some work better for some people, and some work worse. I am excited that, for him, Aimovig seems to be working. It is really nice to have him back.

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