As expected, we’ve been overwhelmed by the demand for the new preventive therapy for migrianes, erenumab (Aimovig). It offers a unique and highly effective therapy with virtually no known side effects, at least so far.
My patients are usually glad to hear that I have migraines (without an aura, but I also have auras without a headache) because I can better relate to their experience. They often ask if I had tried this or another treatment and indeed, I’ve tried many, sometimes less out of necessity but more for the experience. I have never tried drugs such as topiramate (Topamax) or divalproex (Depakote) because they have many potentially serious side effects and I prescribe them very reluctantly after trying many other treatments. I have injected myself with Botox on two occasions, have given myself a nerve block and an intravenous infusion of magnesium.
Luckily, even when I have periods of very frequent attacks, my migraines are easily controlled with sumatriptan tablets or injections. I prefer injections when I want quick relief, such as before going to bed, in the middle of the night, or during a busy work day.
Although over 3,000 patients have been exposed to erenumab in clinical trials and some of them have been on it for 5 years, the true safety of the drug may not be known for at least another 3-5 years.
Even though my migraines do not cause any disability or interfere with my life (except for the need to avoid wine), in the tradition of doctors experimenting on themselves, yesterday I gave myself a shot of erenumab. It was painless and caused no local reaction, which is the most common side effect seen in 5%-6% of patients. This lack of serious and not so serious side effects has been the most surprising aspect of not only erenumab, but also of the other 3 CGRP monoclonal antibodies in development. So admittedly, injecting myself with erenumab was not an act of bravery and I really did it to see if I can drink more wine and take less sumatriptan.
