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Emgality question!

Hi! I’ve been on Emgality about a year for what I call cluster migraines that would about kill me for anywhere from 3-14 days. My sumatriptan would take the edge off for a few hours, but it would come roaring back again. Anyway, I noticed that although I still had manageable migraines, the long, deathly ones seemed to stop! Not perfect, but SO much better than the alternative.
I picked up my June dose with the groceries and asked my Mom to put it in the fridge door. It accidentally went into the freezer! So, I skipped the June dose and started again in July.
Today is day 12 of a migraine! I’m guessing this is due to the missed dose and I’m hoping it will “reset” soon.
Has anyone else missed a dose? If so, how did it affect you? Do I need to start over with a double/starter dose?! I am more or less bedridden when I get this. Any comments or advice would be greatly appreciated! My doc and pharmacist know NOTHING about the deets of this drug, so I came to the experts!

  1. Oh my goodness, so sorry to hear how missing a dose potentially tripped you up from what had been a fairly effective remedy for you. Your description of how Emgality had been providing you with relief- (to take the edge off the most severe attacks such that you still have migraine attacks but more manageable ones) is one we are hearing frequently with the CGRP drugs, of which Emgality is one.

    A couple of thoughts:

    1) If your doctor is willing, it certainly wouldn't hurt to double up your dose in August. Indeed, we frequently hear of community members being prescribed double doses of these injectable CGRPs (Emgality, Ajovy, and Aimovig) on an ongoing basis. I take two injections of Emgality every month as one was insufficient for me. Of course, this must be a decision made between you and your doctor- but it is an option.

    2) You could be experiencing a particularly intense attack that would've broken through your prevention coverage even if you had taken that June dose. This can happen from time to time and leaves us scrambling for logic but sometimes it's just what happens. I say this especially as you mentioned that your prior length of attack was up to 14 days in length (awful!) and here you are at 12. So you're within the range of what has been normal for you.

    3) Keep an eye on things. We've heard that these drugs can lessen or stop their efficacy. This can be a heartbreaking thing when you've found such relief in them. It's not the end of the road, however, as there are many versions of CGRPs, so if you begin to find that Emgality is less effective, you can shift to a different kind and hopefully find relief there. We hear this happens frequently.

    4) You were right to toss the frozen dose. The literature does make it clear that these drugs should be kept carefully at the temp of the fridge and brought to room temperature only once prior to injection.

    Hope this helps. We are certainly thinking of you and hoping you'll be experiencing some relief from this stubborn attack as soon as possible. Please let us know if you have any other questions in the meantime. We are here for you. Warmly- Holly team.

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