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CGRP inhibitors- IV Vyepti and Emgality shots

I have chronic migraines and am currently on Botox every 12 weeks and 800 mg gabapentin for migraines. I still have migraines every day and unable to go to work/have limitations in my everyday activities, since am in constant pain.

I had an appointment with my neurologist and he mentioned about IV Vyepti every 3 months or Emgality every month. He mentioned they are non sedating and does not have side effects except for allergic reactions/rashes(but not for everyone)

Am really nervous about trying this new medication, since I see mixed reviews online about the drug. Has anyone tried Vyepti or Emgality and can you please share your experience. Since these medication take longer to wean off from the body, I am concerned about side effects lasting longer, if I was to quit them worst case due to the intolerable side effects.

I tried Nurtec before but I cant tolerate the smell/taste, which triggers my headache.

Thank you for your time and help!

  1. Greetings - These are great questions. I know it can feel like a lot to take on new treatments as it potentially means experiencing side effects and can take time to both get it to the right level in your system- and then, if it doesn't work out, waiting out challenges while we wean off of it.

    Interesting to hear you've tried Nurtec. This is also in the CGRP family- but there are many different types of these meds out there. Some are preventative; others are rescue, and still others do both! We've heard many people say that just because one CGRP doesn't work for them doesn't mean they all won't.

    I personally take Emgality (and, like you, Botox). I've had success with it in that it helps decrease some of the intensity of the pain I experience. It didn't have any impact on the frequency of my attacks. We are all so different in our pain patterns and how or whether we respond to treatments. That said, I've had no discernable side effects. I notice, just like with the Botox, that I can tell when I'm nearing the end of the efficacy window as the drug wears out in my system before it's time to take it again. We have some good information here from others who are taking Emgality regarding side effects, efficacy, and on:

    I haven't personally tried Vyepti - but have heard a lot about it. We have a lot of resources on this topic - and the best way to take a look at those is to go to our search bar (top left corner of the web page) and then enter "Vyepti" into that bar. That will take you to a list of resources on this approach.

    Wonderful that you are working so hard to try new solutions to address your constant pain related to chronic migraine. I also live with chronic migraine so can understand what you're up against. I have found, like you, that the best chance of experiencing some relief is to seek a combination of medications that make up an overall strategy of preventative and rescue approaches. As there is no one cure for migraine, the goal is to address the symptoms of the condition to decrease the severity and/or frequency of pain and related neurological symptoms.

    Do you have a rescue tactic in your overall treatment strategy? I think of Botox and gabapentin as being preventative. What do you do when you have breakthrough pain? I take a triptan as my rescue. It works just okay- but sometimes taking the edge off the intensity can make a huge difference.

    So glad you're with us and willing to share your journey. Hope you'll keep in touch, Warmly - Holly - team

    1. Thank you for your response. I currently use Tylenol for rescue, Nurtec works sometimes, does not work most of the times. sumatriptan/rizatriptan does not work well for me. I recently read about frovatriptan on and plan to ask my doctor about it.

      1. Ugh- isn't it frustrating to repeatedly try treatments that don't work? Frova may be of help to you. It is in the triptan family- which sounds like hasn't worked for you in the past. But, similar to the CGRPs, just because one version doesn't work doesn't mean another won't. I've never tried frova but I've heard that it's been helpful to many. The triptan I take is eletriptan (relpax). Others I've tried have either not worked or caused troublesome side effects. Please keep us in touch as to the steps you are taking in your migraine journey. We are here for you. Warmly - Holly - team

    2. Has anyone tried emgality, amivog, and they didn’t work and then try Avjoy? I probably am spelling them wrong. I was on both for 6 months and nothing only fat in the stomach. Now after 2 years I am going to try Avjoy and I am a little scared. I have been having horrible migraines, but every time I take a rescue med eltriptriphan I get rebounds because they work and I guess it takes away the headache and then I take too much. I mean every time I get one and then I get rebounds. However, I am so nervous to try another CGRP because none seem to have work and I gain weight. My headache specialist seems to think I should try. So has anyone tried two and then a third one worked? Thank u

      1. I'm sorry to hear that you're experiencing such pain and so many rebounds.

        I found this article that you might find helpful. It's a discussion on why some CGRPs work and others don't.

        This article is when medications stop working...

        And this last one talks about the combination of Ajovy and botox...

        I hope that you find one or all of them helpful. I'm just trying to share some resources that might help to give you the clarity that you're looking for in making this decision.

        I'm sure others will join the conversation here too, in sharing their personal experience.

        Keep us posted on how you do, if you feel comfortable doing so. We'll be thinking of you!
        Alene, moderator

      2. thanks for reaching out on this. First, good for you for continuing to seek solutions. I think most people don’t understand the difficult process of trying new treatments due to the fact that we green experience side effects that rival the migraine itself. It makes sense that you’d have trepidation about trying yet another CGRP when you’ve had challenges with them before. The first link sent you above speaks to the fact that Ajovy and Emgality are quite similar in design. So we often hear of people who try one of those and if it doesn’t work, turning to Aimovig. For many if Emgality doesn’t work (or causes issues) the same experience may occur with Ajovy. That said everyone is different and unique in the way that we respond to treatment such as these.

        Have you ever discussed one of the other types of CGRP treatments with your doctor? There are ones called gepants, for instance that, while in the same family as the CGRP meds, are made differently. You may ask about Nurtec, Qulipta, or Vyepti - to name a few. Some of these work preventively, others as rescue, and still others as both! Might be worth exploring. If you’d like to learn more about any of those I mentioned, just enter the name of the treatment into the search bar (top left) to take a look at the relevant resources we have.

        And I’m with you on the Eletriptan. It’s very tempting to use frequently because it works! As you’ve outlined, it can be very difficult to find treatments that are effective without trouble some side effects.

        We are with you as you continue on this journey. Please stay in touch and let us know if you have any additional questions. We are here to provide information and support anytime. Warmly - Holly - team

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