Treatments
Preventive medication reduces the frequency, intensity and duration of future migraine attacks. A good solution when you have attacks very regularly or when the attacks are very severe.
We prevent migraine with CGRP inhibitors: monoclonals and gepants, the first medicines developed specifically to prevent migraine.
Our approach
Different people respond differently to different medicines. Starting preventive medication is therefore a process of trying things out to find the best solution. That is only possible with a very personal approach.
We try things out together, step by step, until we find the preventive medicine that suits you best.
At The Migraine Clinic we keep a close eye on whether the preventive medicines actually have a positive impact on the patient. We look not only at effectiveness, but also pay careful attention to any side effects. That is how we aim for the best possible care.
The breakthrough
CGRP inhibitors are the most important breakthrough of the past ten years in the treatment of migraine. These medicines block the protein CGRP, which plays a crucial role in the onset of migraine. These treatments were developed specifically for migraine.
75%
of our patients are still using CGRP inhibitors after a year
It has been known since the 1980s that the protein CGRP plays an important role in migraine. This protein is released from the headache nerve and causes inflammation-like reactions that produce migraine pain.
There are two kinds of medicine that block this protein: monoclonal CGRP antibodies and gepants. They work by blocking CGRP before it can take effect, or by blocking the receptor that CGRP acts on.
More than five years of scientific research confirms their effectiveness and good tolerability, with no dangerous long-term side effects. NICE (the National Institute for Health and Care Excellence) also recommends CGRP inhibitors as a preventive treatment for migraine.
Self-injection every 4 weeks
Erenumab, sold under the brand name Aimovig, was the first CGRP inhibitor to come on the market. It works by blocking the CGRP receptor, so the protein cannot take effect. Erenumab is given every 4 weeks as an injection under the skin with an auto-injector.
After instruction, patients can give themselves the injection at home. Common side effects are reactions at the injection site and constipation. In general, erenumab is well tolerated.
Self-injection every 4 or 12 weeks
Fremanezumab (Ajovy) targets the CGRP protein itself, rather than the receptor. It can be given every 4 weeks or once every 12 weeks, which offers flexibility for patients who want to inject less often.
The 12-weekly option makes fremanezumab particularly suitable for patients who prefer less frequent doses.
Self-injection every 4 weeks
Galcanezumab (Emgality) binds to the CGRP protein and so prevents it from taking effect. It is given every 4 weeks with an auto-injector. The first time, a double loading dose is given for a faster effect.
Tablet
Atogepant (Aquipta) is a gepant taken as a tablet. Unlike the monoclonal CGRPs, it blocks the CGRP receptor with a small molecule. We prescribe it both to prevent migraine attacks and for the acute treatment of an attack.
For patients who would rather not have injections, it offers an attractive alternative with comparable effectiveness.
Tablet
Rimegepant (Vydura) is a gepant taken as a tablet. Unlike the monoclonal CGRPs, it blocks the CGRP receptor with a small molecule. We prescribe it both to prevent migraine attacks and for the acute treatment of an attack.
For patients who would rather not have injections, it offers an attractive alternative with comparable effectiveness.
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