injections

7 September 2020

CGRP Medication Side Effects – “I hadn’t thought of that…”

James Discoveries & Stats, Medications 0

One of the things patients like about CGRP related migraine medications is that the side effects are often less than with other drugs. But there can be side effects.

Calendar clock — Side effects – mostly temporary…?

A recent study used a checklist to see if patients would notice other side effects that weren’t so obvious, or that they might not think of right away. The researchers were concerned that some of these were missed in some of the original trials.

This particular study was presented at the 62nd Annual Scientific Meeting of the American Headache Society, and came from the Chicago Medical School and Robbins Headache Clinic. 119 chronic migraine patients were first asked about side effects generally, and then they were handed a checklist.

The study itself is arguing for the use of checklists to identify side effects, but for us it is interesting to see which adverse effects were noticed using the checklist.

These patients had been on therapy for two months. What about you? If you’ve taken a CGRP related drug, have you noticed any of these? Here are the most commonly reported ones:

Constipation
Anxiety
Injection site reaction/irritation
Insomnia
Hair Loss
Muscle Pain/Cramps
Joint Pain
Irritability
Increased Headache
Depression
Nausea

Again, remember that generally speaking side effects from these medications have been mild. Some also go away with time. For example, many patients experience increased headache for a few days or a couple of weeks, but then start to feel better. Weight gain lasted from 1-4 months. Of course injection site reactions were usually very brief.

However, some symptoms could be ongoing, so do check with your doctor. Hair loss, constipation, and sexual dysfunction, for example, seem to last longer (but again, many people have no problems whatsoever).

What’s been your experience?

(Study abstract here (scroll down): CGRP Monoclonal Adverse Effects: Evaluation Via Use of a Checklist

10 September 2019

New Triptan Study (and is it really useful?)

James Discoveries & Stats, Medications 0

Triptans – medications that were specifically designed to fight migraine pain – come in a number of varieties. So, which ones are the most effective? A new study attempts to answer that question.

The study, published in the European Journal of Clinical Pharmacology, compared various triptan medications. Probably the most well known is sumatriptan, partly because it was the first one to come out years ago. But as we’re discussed in the past, sumatriptan doesn’t work for everyone. Some people who have not found it helpful at all have had great success with other triptans.

For more of an introduction to triptans, see 10 Triptan Facts You Need to Know Now.

So who was the “winner”? Surprisingly, it was eletriptan, a 40mg dose. The “loser” was naratriptan. Both of these were oral doses.

The difference between the two? Well, about three times more people were pain free at two hours with eletriptan than with naratriptan, so all the other triptans would fall between the two.

So – oral dose, you say. What about in injection? Or those nasal sprays? Aren’t they better?

Actually, they compared nasal sprays, oral, and subcutaneous (injections). Of course, most of the variety out there is with sumatriptan, so that’s where most of the information comes from. In short, the injections had the advantage of being quite a bit faster, but oral and nasal spray were about the same for effectiveness.

So just how useful is this information? Should everyone just run out to buy eletriptan? In oral form?

Well, there are some serious limitations with this study. As I suggested before, there’s a lot more information (and variety) for sumatriptan.

But perhaps even more importantly, there are some important reasons why one triptan may work for you and another may not. You may be taking other medications that could interact with a certain triptan. One may work better for women, or older patients.

So yes, maybe doctors and patients should pay a little more attention to eletriptan as a good option. Maybe you should even try it first (before other triptans, that is). But talk to your doctor, because she may have suggestions for you, far beyond “this happens to work better for most patients in clinical trials”. Everyone is different, with a different medical history and a different biological make up.

So how useful is this study? It’s worth raising an eyebrow and reconsidering what triptans we prioritize, as we look at it along with other trials. It also says good things about oral medications, and injections. But again, there are lots of other studies that say good things about nasal sprays – it depends on the person.

You can read the abstract here: Efficacy of triptans for the treatment of acute migraines: a quantitative comparison based on the dose-effect and time-course characteristics

18 May 2018

Big News: First CGRP Inhibitor for migraine Approved in US – Aimovig

James Uncategorized 6

Yesterday, the FDA approved the first of a new class of migraine drugs – CGRP monoclonal antibodies. We’ve been talking about these drugs – and this one in particular, for many years. And it should be available in the USA in a couple of weeks.

Aimovig The drug is being sold as Aimovig, but we’ve known it by its earlier names, AMG 334 and erenumab.

Aimovig, and it has been approved as a migraine preventative. This is what the FDA had to say about it yesterday:

The U.S. Food and Drug Administration today approved Aimovig (erenumab-aooe) for the preventive treatment of migraine in adults. The treatment is given by once-monthly self-injections. Aimovig is the first FDA-approved preventive migraine treatment in a new class of drugs that work by blocking the activity of calcitonin gene-related peptide, a molecule that is involved in migraine attacks.
[FDA Press Release]

For a somewhat lighthearted basic explanation from 2012, check out The Secret of CGRP.

Aimovig dosage

Aimovig Injector Aimovig is currently a 70mg injection taken each month. Some patients may take a double dose, which would mean two injections of 70mg taken the same day. The injection, done with a pen-like “autoinjector”, is taken in the abdomen, upper arm, or thigh. It’s designed to be injected by the patients, but there are some things to watch for, so talk to your doctor. The injection takes about 15 seconds.

Aimovig Side Effects and Other Concerns

Some of the headlines are claiming that this is a wonderful new side-effect-free medication, which is not strictly true. The side effects do seem to be minimal, which is certainly the general advantage. However, a few patients were irritated by the injection itself. Some also experienced constipation. There are also cautions because of the unknowns of taking Aimovig during pregnancy, and researchers are concerned that there may be an increased risk of preeclampsia.

But for most people, the side effects should be minimal or non-existent.

Advantages of Aimovig

Aimovig seems to be helpful for patients with episodic and chronic migraine, although you will need to discuss with your doctor if your attacks are frequent enough to warrant this type of medication.

As mentioned before, you may experience fewer (or no) side effects with this medication compared to what you have tried before. If you have not used a preventative medication before, your doctor will probably try some other drugs or treatments first before Aimovig.

Aimovig may not prevent all your attacks. If they cut your attacks by a third or a half, that will be a significant improvement.

However, using Aimovig with other treatments could mean a much more significant improvement. And remember, this is only the first of this type of drug to hit the market – other CGRP drugs could work better for you. And there are a whole new class of drugs coming after that.

Another interesting note – this drug is currently being investigated as a possible treatment for hot flashes during menopause.

We will look forward to hearing about your experiences with Aimovig. Once you’ve tried it, come back and comment!

5 January 2018

More Clues about how CGRP Drugs will Prevent Migraine

James Discoveries & Stats, Medications 0

As we continue to wait for the first CGRP inhibitors to hit the market, clinical trials are giving us more clues about how the medications will actually work.

One of the most interesting trials was published at the end of November. Fremanezumab was the drug, and the target group was patients with chronic migraine (that is, headache pain more than 15 days per month, and specifically migraine attacks at least 8 days).

One group received 675mg every three months by injection. Another group had a 675mg injection the first month, then 225mg the next two months.

Now, let’s look at the results.

fremanezumab trial This is a helpful chart, but let me explain it. There are three sets of data. First, those who had a quarterly injection (before, and after, basically), then those who had a monthly injection, and then a placebo.

So you’ll see that the quarterly and monthly injections were very similar, with the monthly being slightly better. Essentially, about four and a half headache days disappeared on average, or about a third.

Now we know that every patient is different, so here’s some other interesting information. Almost 40% of patients had a 50% reduction in headache days.

I don’t know if you noticed the same thing that I noticed or not, but here it is. The quarterly group and monthly group were very similar. So – for many patients, a quarterly injection may make a huge difference in their lives.

I realize some people hate injections, but for a lot of people, an injection every three months will be a lot better than a pill twice a day.

Obviously with a brand new medication we’re still learning about which doses work best. So hopefully we can find ways to use CGRP inhibitors which will show an even greater improvement for many chronic migraine patients.

You can read more about the study here: Fremanezumab for the Preventive Treatment of Chronic Migraine

10 August 2017

Pioneering Stem Cell Research for Migraine

James Discoveries & Stats, Treatments 0

A study published earlier this year is raising questions about the use of stem cells for the treatment of migraine. Although the results weren’t spectacular, they do show promise. Let’s see why.

This was only a small open-label study. 9 people (8 women and 1 man) were enrolled. Stem cells were taken from the patient, tested for viability, and then injected into the temporalis, occipitalis, neck, and trapezius muscles.

Stem cells & Migraine

Now, this is going to be one of those good-news-bad-news things, so bear with me.

Obviously this was just a small study. However, the good news is that 7 of the patients did see a decrease in their MIDAS score. MIDAS is a test designed to measure the disability caused by your migraine attacks (read more about MIDAS here). Scores decreased overall by almost 28%.

So that’s great news. However, for most of those patients, the improvement was fairly small. And for all of them, it was temporary (although the study only lasted three months).

For two of the patients, the improvement was quite significant.

But don’t worry, there is more good news. These were patients who generally had suffered with migraine for a long time, and had tried many other treatments. The mean age was 48, and the mean number of years with migraine was 16. They had all tried at least three preventative medications and also had tried onabotulinumtoxinA (Botox).

So these 9 patients were not the easy-to-treat kind. The fact that two saw significant improvement is important.

We’ve talked about stem cell research for migraine and headache before. If this treatment could help even a quarter of hard-to-treat patients, it would be a major breakthrough.

You can read the full study here: Stem Cells in the Treatment of Refractory Chronic Migraines