Erenumab for trigeminal neuralgia and other news from the American Headache Society meeting
The annual scientific meeting was held last weekend in Philadelphia. The largest number of presentations was about the CGRP drugs, both monoclonal antibodies (mAbs) for the prevention and soon to be approved oral medications for the abortive treatment of migraine attacks. In addition to the three currently available mAbs, erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality), which are self-injected subcutaneously every month (Ajovy can be given every 3 months), a fourth intravenous mAb, eptinezumab, which is given every 3 month, is likely to come out early next year.
Two oral CGRP drugs that are in development are taken as needed for an individual attack of migraine. These drugs are rimegepant and ubrogepant and they are expected to be approved by the FDA in about 6 months.
One interesting presentation by N. George and Z. Ahmed from the Cleveland Clinic and other Cleveland hospitals described 8 patients with trigeminal neuralgia (TN) who also suffered from migraines and were given injections of erenumab (Aimovig). Six out of 8 reported good relief of their neuralgia along with migraines. It is possible that the neuralgia pain was part of their migraine, but it may still be worth trying erenumab in patients with TN who do not respond to standard therapies or Botox.
I showed this post to my neurologist and asked if we could try Aimovig. Within 4 days of my first injection I became pain free and was able to discontinue my daily Tegretol and Morphine. However after a year I began to experience pain again. I switched to Emgality and have been pain free for 2 years now
No, I haven’t had any patients complain of tinnitus from erenumab (Aimovig). I checked the report by Dr. Larry Robbins where he compiled many side effects of CGRP monoclonal antibodies such as erenumab and tinnitus is not listed there either.
Thank you, Dr. Mauskop, for your response. I have gotten free samples in the past, but my neurologist says his supply is drying up. But I’m sure he will continue to provide me with what he can. On a related note, are you aware of any link between the CGRP injectables and the onset of tinnitus? I began experiencing tinnitus very shortly after receiving my first Aimovig injection in 2018. (I have since switched to Emgality, which is more effective for me.) My neurologist is skeptical of the link, but the timing is suspicious. At this point, the dramatic pain relief is worth putting up with the tinnitus, but it is bothersome and seems to be worsening over time. I’ve not been able to find documentation of a link between these drugs and the onset of tinnitus. Thank you for any insight you may have. Your blog is a very valuable resource!
Yes, it it most likely that the lower, 120 mg dose of Emgality is not sufficient. For cluster headaches, the dose is 300 mg a month. You may want to ask your neurologist to get you some free samples from the manufacturer.
Although this blog post is nearly two years old, it’s very relevant and helpful to me. I’ve been taking a double dose of Emgality for nearly a year with excellent results. My migraine attacks have been significantly reduced and my trigeminal neuralgia pain has been non-existent. However, for financial reasons I cut back to a single dose of Emgality for the past two months, and the TN pain has returned, albeit intermittently (migraine attacks have also increased). I was wondering if the lower dose of Emgality might be the reason for the TN pain, and it seems that it could be. Thank you for this information!