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Date issued: March 2024

Review date: March 2026

Ref: A-615/RS/Neurology/Migraine treatment options

PDF:  Migraine treatment options final March 2024.pdf [pdf] 192KB

We have written this document as an overview of all treatments that are available for migraine, including side effects and effectiveness so that you can make an informed decision before meeting the headache nurses and talking through your options. Please feel free to talk this through with your family and friends so that you have any questions ready to discuss with your nurse.

This group of medicines are referred to as Monoclonal Antibodies (MaB’s) GePANTS and anti CGRP medicines. This means that they all try to stop the activation of CGRP which migraine sufferers have more of, from binding to receptors setting off a chain of events that play an important role in migraine. However, they are all given in different ways and have different side effects.

None of these medicines are cures for migraine and each person will get a different response. It may be that it doesn’t work at all, in which case you may decide to try another treatment option.

Botulinum Toxin (Type A Botox)

Given by a nurse in outpatients setting.

No excessive exercise, rubbing or bending down advised for 24 hours after treatment.

31 very small injections into the head neck and shoulders.

May take 2 treatments three months apart to notice an improvement.

Contains human albumin.

Common side effects (may affect up to 1 in 10 people)

• Temporary increase in headache

• Weakness of some facial muscles

• Drooping of the eye lid (ptosis-not permanent)

• Neck stiffness for a number of days

Erenumab (Aimovig)

Delivered to your home.

Kept in the fridge (2 and 8 degrees)

Does have latex in the cap of the injection.

An injection pen given to yourself once every 28 days into the abdomen or thigh.

Contains animal product.

Can take up to five months to be out of your system.

Common side effects (may affect up to 1 in 10 people)

• Allergic reactions such as rash, swelling, hives or difficulty breathing

• Constipation

• Itching

• Muscle spasm

• Injection site reactions, such as pain, redness and swelling where the injection is given

Fremenezumab (Ajovy)

Delivered to your home

Kept in the fridge (2 and 8 degrees)

An injection pen given to yourself once per calendar month or all three on the same day in the abdomen or thigh.

Contains animal products.

Can take up to five months to be out of your system.

Common side effects (may affect up to 1 in 10 people)

• Pain, hardening or redness at the injection site

• Itching at the injection site

• Rash at the injection site

Galcenezumab (Emgality)

Delivered to your home.

Kept in the fridge (2 and 8 degrees)

An injection given to yourself once per calendar month in the abdomen or thigh. The first month two injections are taken as a loading dose.

Contains animal products.

Can take up to five months to be out of your system

Common side effects (may affect up to 1 in 10 people)

• Constipation

• Skin reaction at the injection site

• Vertigo

Eptinezumab (Vyepti)

Given in a clinic by a nurse through a cannula (plastic tube into the hand or arm) over a half hour infusion every 3 months.

Contains animal products.

Common side effects (may affect up to 1 in 10 people)

• Nasopharyngitis (an inflammation of the nasal passages)

• Hypersensitivity

• Reaction to the infusion

• Fatigue

Rimegepant (Vydura)

Only for episodic migraine sufferers (4-8 attacks per month)

Buccal (oral dissolves in your mouth) taken every other day.

Contains fish gelatine.

Stays in your system for 5 days. A high fat meal will reduce its effectiveness.

Common side effects (may affect up to 1 in 10 people)

• Nausea

• Hypersensitivity

• Rash​​​​​​​

Atogepant (Aquipta)

A tablet every day

Not for those with severe kidney or liver problems

Stays in your system for 5 days

Vegan

Common side effects (may affect up to 1 in 10 people)

• Nausea

• Constipation

• Tiredness/sleepiness

• Decreased appetite

• Weight loss