While these trials are promising, there are still some considerations to keep in mind related to erenumab’s mechanism of action.

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If you suffer from migraine headaches, you will likely have tried a range of treatments to ease the pain and any other migraine symptoms you suffer. Now there is a new medication available: erenumab (Aimovig). Erenumab, approved by the U.S. Food and Drug Administration on May 17, is treatment that is specifically designed to prevent migraine.

How Erenumab Works

Erenumab prevents migraines by blocking a gene—the calcitonin gene related peptide receptor (CGRP-R)—that plays an important role in migraine. Studies have shown that CGRP-R levels are elevated in the jugular vein (a vein in the neck that carries blood from the head, face and brain back to the heart to be re-oxygenated), and that levels of CGRP-R fall when migraine symptoms are relieved by standard migraine drugs, such as triptans. Other research has shown that injections of CGRP-R can trigger a migraine attack. The fact erenumab blocks the action of this gene makes it a valuable new player on the field of migraine drugs.

Migraine Symptoms Can Be Disabling

It is vital to be able to control migraines because it can be a disabling condition, resulting in severe, pulsating head pain, nausea, vomiting, and sensitivity to light, sound, and even odors. Migraine symptoms can limit your ability to perform everyday tasks of living, and are associated with an overall reduced quality of life. According to the World Health Organization, migraines are one of the top 10 causes of years lived with disability for both men and women. While drugs and other treatments have been developed to try to prevent migraine attacks, these therapies are not specifically designed for prevention but rather are repurposed from other indications. Their efficacy is often poor, and they also may cause side effects.

Evaluating Erenumab

Several large global randomized studies, including more than 3,000 people, have been carried out to examine how well erenumab works, and how tolerable and safe the drug is. On June 28, 2018, the results of two new studies of erenumab were announced by the drug’s manufacturer. One study focused on the benefits of erenumab for people with chronic migraines (categorized as having 15 or more migraine days per month), while the other analyzed how well the drug worked in people with episodic migraines (categorized as four or more migraine days per month).

In the study that included people with chronic migraines, the main focus was on the long-term safety and efficacy of erenumab. The safety results after one year matched up to the safety profile seen for erenumab in previous studies. Some people in the study did develop side effects while taking erenumab—most frequently, they reported viral upper respiratory tract infection, upper respiratory tract infection, sinusitis, arthralgia, and migraines. The efficacy data for erenumab showed sustained benefits up to one year. Compared to a baseline of 18.1 average monthly migraine days, patients taking erenumab in either a 140 milligram (mg) or 70 mg dose respectively achieved a:

• Substantial reduction of average monthly migraine days (10.5 and 8.5 days)
• 50 percent or more reduction in monthly migraine days (67 percent and 53 percent)
• 75 percent or more reduction in monthly migraine days (42 percent and 27 percent)
• Migraine-free status (13 percent and 6 percent)

“These data showing sustained efficacy and consistent safety and tolerability of Aimovig over an extended period of time are important for migraine patients and their clinicians to know,” said Stewart J. Tepper, MD, professor of neurology at Dartmouth Medical School’s Geisel School of Medicine. “Collectively these data reinforce the safety and tolerability of Aimovig, and having a treatment specifically designed for migraine has the potential to truly improve the lives of those living with this neurological disease.”

The results of the study assessing erenumab’s safety for people with episodic migraines showed that the drug had a safety profile consistent with rate and type of adverse effects seen in previous studies. The most frequent adverse effects reported in this second study were viral upper respiratory tract infection, upper respiratory tract infection, sinusitis, influenza, and back pain (there were no new adverse effects).

Is Erenumab For You?

While these trials are promising, there are still some considerations to keep in mind related to erenumab’s mechanism of action. CGRP has a range of functions within the body—for example, it plays a role in vasodilation (the widening of blood vessels), a process that can help mitigate the cardiac and cerebrovascular ischemia that underpins heart attack and stroke. This means that inhibiting CGRP could be risky in people with cardiovascular issues and people who are high-risk for stroke. So far, studies into erenumab’s safety have not indicated that is raises cardiovascular risk—but that could be because the majority of people who took part in the drug trials were relatively young (mean age 40 years), and cardiovascular and cerebrovascular risks typically rise with age.

As with all new drugs, the cost of erenumab ($575 per month) is higher than for older drugs. This means that clinicians will likely seek to prescribe the drug to a select population that is most likely to benefit. If you are gaining sufficient migraine symptom relief from your present migraine drugs, switching to erenumab may not be cost-effective. However, you should discuss the new drug with your doctor if you suffer from disabling migraine symptoms that are not controlled by your present drug regimen, and your cardiovascular health is good.

For related reading, please visit these posts:

• Migraine Symptoms: Treatment (and Prevention) Tips
• Melatonin Benefits: A Surprising Treatment for Migraine Sufferers
• How to Overcome Migraines Naturally 
• A Strange But True Home Remedy for Migraine Headaches: Self-Inflicted Brain Freeze
• Migraine Medication That Can Ease Your Pain—and Home Remedies That May Help
• A Look at the Causes of Migraines and the Latest Migraine Treatments

This article was originally published in 2018. It is regularly updated.