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A hand reaching into a medication bag from a pharmacy.

Tips for Timing Your CGRP Medicines

CGRP medicines are a brand new type of migraine drug that’s on the market. The three that are out—Aimovig, Emgality, and Ajovy—are all administered as monthly injections. I’m about to take my third dose of Emgality. Through my own experiences, and talking with others in our forums and online, I’ve thought of and heard of a few tricks for finding your best timing of when to take the medicine.

It’s important to mention that when deciding anything about when or how you take a medicine, you should always consult with your doctor first. These are new medicines and we are still learning about them, and so it’s really important to follow your doctor’s guidelines.

Consider waiting to take the first dose

Depending on how desperate you are to try the medication, this one may or may not jive with you, and that’s fine. From the migraine community, however, I’ve learned that it’s not that uncommon to wait to take the first dose as many of us are new to self-injecting. We also may be nervous to try a new medication without knowing what the side effects could be. I was in the latter category. I waited a full week from when I filled my first dose of Emgality till when I administered it—but now I’m really glad I had.

There was a hiccup in getting coverage under the Emgality savings plan and my third dose was filled late. Since I didn’t need it on the fill date it still worked out that I didn’t have to take my medicine late. So to avoid any delays in getting your dose from insurance or paperwork hiccups, you may consider holding off—if your doctor agrees—so that potential delays won’t affect your dosing schedule.

Consider special events

Since it’s a medication you take every 28 days it’s easy to look ahead and see if you will need to take your next dose on a day you’re traveling or attending an important event. Also, some people in the Emgality support group I’m in have mentioned that the medicine wears off towards the end. If you are one of those people, you can try to time it so that you’ll be taking your medicine before the event. You can always ask your doctor if it’s ok to switch up the days.

Consider menstrual migraines

Again, some people have mentioned that their medicine wears off towards the end of the month. If your cycle is regular and predictable, and you also deal with menstrual migraines, you might want to time it so that your not due to get your period at the end of the 28 days. I (accidentally) scheduled it so I get my period right in the middle of my one month doses. This is helpful because it has not worn off for me at that point. I only had one menstrual migraine last month!

Time it right for side effects

So far I haven’t had any significant side effects but I thought I’d pass along something I’d heard in a support group. A woman who takes one of the CGRP medicines usually experiences fatigue for the first few days, so she always takes her medicine on Fridays so she can have the weekend to rest. This is something to consider if you also experience side effects. Again, if you need to alter your dosing schedule to make this happen, it’s best to discuss it with your doctor beforehand.

Did I miss anything?

I’d love to hear if you have any thoughts/tips/insights on timing your CGRP meds to be as effective and convenient as possible. Leave us a comment below!

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • dado
    1 month ago

    I am currently on Aimovig and have been so for over a year. Recently I’ve been contemplating stopping my Botox injections. I take other meds also but I just want to be able to see what drugs are working and which ones aren’t. Between all the side effects and not knowing if anything is really helping I’m a little fed up.
    I’m glad I read this article I hadn’t realized that insomnia was a side effect, I don’t sleep much anyway but even less recently. Thanks for the info and Aimovig is great about bridge programs.

  • jlewit
    1 month ago

    Hi lisa i tried amovig for my migraines and i wasnt a big fan of it simply because of the auto injector and it also made me feel dizzy after taking it

    Ive also tried the ajovy and liked that one but didnt help with my headaches

    Never heard of the emgality one

  • lindaann
    1 month ago

    I have taken Aimovig for almost a year. It worked great for the first almost 9 months, so I went off my other preventative, topomax. I still had a few good months, then suddenly it was as if I was back to baseline. Has anyone had the experience of it stopping working? Wondering if I need to go back on topomax (yuck) or give it a bit longer. Just seems like nothing helps for very long.

  • Lisa Robin Benson moderator author
    1 month ago

    I’m sorry you’re going through this, Lindaan! I don’t know if we know yet since the drugs are so new. I’ve been on Emgality for just 6 months. I hope you find relief some way or another!

  • Elizabeth M
    1 month ago

    Thought this was going to be about timing after filling. It’s important to read the leaflet. Must be sat out to reach room temp and be at room temp for 1/2 hour and taken no more than 7 hrs after you sat it out. Otherwise it is no good.

    Because life isn’t complicated enough with migraines, right?

  • Any01970
    1 month ago

    Actually, If removed from the refrigerator, Aimovig should be kept at controlled room temperature (up to 25°C [77°F]) in the original carton and must be used within 7 days. Throw away Aimovig that has been left at room temperature for more than 7 days.

    https://www.aimovig.com/aimovig-dosing/

  • Lisa Robin Benson moderator author
    1 month ago

    For real, Elizabeth!

  • NellyBly
    1 month ago

    I took CGRP drugs for a little more than a year — I’ve taken both Aimovig and Ajovy (complicated insurance issues). I probably would have waited to take my first dose, out of nervousness, but it arrived by mail and my elderly mother had not put it in the refrigerator as directed and I wasn’t sure what I should do, so I just injected it. For about 10 months, CGRP was life-changing. BUT — there were a couple of unanticipated side effects. One was constipation, which is not a deal breaker but merely an annoyance. The second was CRAZY BAD INSOMNIA — I’m talking multiple nights in a row, after injecting a dose, of not being able to go to sleep till past 3, or 4 or even 6 a.m. a couple times. The insomnia tended to recur fitfully throughout the rest of the month. Mind you I’ve always been a bit of an insomniac, but not normally so ferociously and usually no more than one night at a time. However, I didn’t have a major attack in 10 months, so I was willing to deal with it. Around the start of summer the drugs started to be less effective and I began having attacks again. They weren’t as bad as my pre-CGRP attacks (a normal attack for me was three days of completely incapacitating pain, nausea and copious vomiting a couple times a month) but they were getting to be bad enough to keep me in bed some days. I started waiting longer than one month to take the dose, and I took my most recent dose at the start of October. Since then, the constipation has tapered off and my sleep patterns are back to normal (for me). Until this week I hadn’t had a bad attack, but one started Sunday night and continued through Tuesday. It wasn’t as severe as pre-CGRP (no vomiting, yay) but bad enough to keep me from working or leaving the house.

    I would have considered asking for the increased dosage, but the thought of what that might mean in terms of ramping up my insomnia and constipation is just too much for me to face at the moment. If my migraines go back to how they were… well, I’ll cross that bridge when I come to it.

    I hope for some it will be a permanent solution to their migraine woes — but 10 months without a serious attack was a wonderful thing.

    Oh, one more thing — for the problem of getting meds on schedule, both Aimovig and Ajovy have ‘bridge’ programs to help people stay on their medication while awaiting approval from insurance companies (don’t get me started on the ridiculousness I encountered from my insurance on getting it covered — seems like they’ll do almost anything to avoid paying).

    Best of luck to you all!

  • Any01970
    1 month ago

    thank you for that info on the “bridge” programs, had no idea that existed.

  • Lisa Robin Benson moderator author
    1 month ago

    Thanks for your story, NellyBly! Also, the Bridge Programs are helpful to know about!

  • MMS1956
    1 month ago

    I had to laugh when I read the first part of the article about delaying using it! Are you kidding?? I was practically waiting at my door for the courier delivery of my Aimovig and ripped open the box immediately, put it in my pocket to warm it up from the ice pack and injected it about 15 minutes after the delivery. Why wait? I’ve been waiting for a medicine like this for eight years. I suffer from daily Chronic migraines and am desperately waiting for a “cure”. Well I’ve been on Aimovig now for a year and while it has reduced my average pain level I’m sure glad I’m not paying for it. I’ll keep taking it until the next drug is approved in Canada or they start charging me for the Aimovig. Not a miracle for me yet. Hope it’s working as advertised for most. I’ll just stick to my Tramadol, ice packs, etc etc.

  • AimeeD
    1 month ago

    Right there with ya. I can’t imagine not taking it ASAP, too funny

  • Lisa Robin Benson moderator author
    1 month ago

    Hope that things change quickly so that we don’t even have to worry about insurance delays, etc. Then no one will have to follow that line of advice. For me it was just serendipitous. There were some other life situations I didn’t mentioned that also caused my delay in the first dose. MMS1956, I’m glad that your pain levels have lowered and hope you find continued relief!

  • Reyk
    1 month ago

    I take 2 Benadryl before my injections because of skin reactions. Since it knocks me out I give my shot close to my bed time.

  • Lisa Robin Benson moderator author
    1 month ago

    I also take Benadryl for the skin reaction and it helps! Thanks for the tip!

  • Ivabrm
    1 month ago

    Can you please let me know what is the name of the Emgality Support Group? I would love to hear from other people and share my questions with the group. I just took my second dose of Emgality.

    Thanks!

  • Lisa Robin Benson moderator author
    1 month ago

    It’s a group on Facebook called “Emgality (galcanezumab-gnlm) for Migraines”, hope that helps!

  • Gracious
    1 month ago

    i have used Aimovig for 1 year and gone from chronic, sometimes daily, incapacitating migraines to 2-3 days a month of mild discomfort that can resolve with ibuprofen and has never last more than 24 hours. it is a miracle I hope never fades. thank you for this article. 1 thing not mentioned that I have no insight on, but would like to know if others do– do others sense that taking the injection when they are having migraine symptoms in any way diminishes its month-long efficacy. i have no mechanism to support this, maybe simple superstition. thanks

  • AimeeD
    1 month ago

    And I can’t imagine it affecting the month long efficacy

  • AimeeD
    1 month ago

    Hi Gracious, that’s such great news for you. I hope you continue to get those kind of results!
    I’ve also been on Aimovig for over a year and while I wish my results were as amazing as yours, they just aren’t… but I’m hopeful another Anti- CGRP will be the answer.
    Though I will say I have noticed that my migraines aren’t as severe as previous, but they are still chronic, around 15 a month.
    I also get cluster headaches, so my doctor and I are trying to get me on Emgality as it’s the only one approved for cluster as well. But Emgality is making it difficult as their patient support program is not available for those without insurance, which I currently don’t have..

    Anyway, to answer your question 🙂 I have taken Aimovig during a migraine in hopes it would resolve it but it did not.
    Though I hear next month an acute anti cgrp medication is being approved, so we’ll see. The science is definitely there, fingers crossed!

  • NellyBly
    1 month ago

    Hey Aimee — listen, I hate to chime in with unsolicited advice since all of us with migraine tend to get more than their fair share of that (Maybe you need to drink more water! Maybe you need to change your diet! — Gee thanks Einstein, I never would have come up with those ‘solutions’ without your help)

    However, when I saw you mentioned you have cluster headaches, I wondered if you had tried oxygen therapy. It was something I looked into for myself, but I don’t have cluster headaches, and the research is pretty clear (although there is some research around use of hyperbaric chambers for regular migraine — which I tried on my own dime, but didn’t help me)

    Anyway, possibly you’ve already tried it, but I thought I’d mention as in my experience not all doctors (even neurologists) are well-versed in migraine treatment.

    Best of luck and hope you have a migraine-free day!

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