Why Have I Started Using Qulipta for Migraine Prevention?

For the last year and a half, I've been lucky enough to be on a migraine regimen that has mostly kept me from debilitating migraines. When I do experience them, their duration and intensity are shorter and less miserable than they used to be, and I haven't needed to receive IV treatment or miss several days of work on end due to being incapacitated. For me, this is a huge win. I went through a lengthy period of time in which migraines knocked me down all too often, kept me down with no end in sight, and required significant and invasive measures to disrupt the cycle.

After switching from a neurologist to a migraine specialist at a headache clinic, we had a lengthy discussion of the ways to come at both preventing migraines and managing/stopping migraines once they have come into play.

Why have I struggled with migraine prevention?

My immediate struggles have for the last 5 years been with the prevention of migraines, because I have continually been in the process of trying to conceive, undergoing IVF, being pregnant, breastfeeding, undergoing IVF, and/or experiencing recurrent miscarriages. Most, if not all, of the traditionally marketed migraine preventives are not safe for the activities above.

Therefore, I'd previously been told that I had no options until I was done trying to build my family and that I could only try to stop migraines once they started, even though we were able to determine that one of my biggest migraine triggers is my hormones, specifically my estrogen levels.

This had been so discouraging for me – there was a whole category of medicine unavailable to me (and to every other woman in the same situation)?²

What treatment did my doctor recommend?

My new doctor shared with me that while this was "traditionally" the case, there was a newer medication called Qulipta that he wanted to tell me about. Here's a quick summary of what I learned:

Qulipta^® is a medication that falls into the CGRP category alongside the traditional preventatives of Aimovig^®, Ajovy^®, and Emgality^®, but rather than an injection, it's an oral medication. Note: As someone who's nearly 1,000 injections into their family-building journey, the injection part isn't what made me hesitate about the other three CGRP drugs.¹

Why wouldn't other CGRPs work for me?

Now, it can take up to 2 to 3 months to see the full effects of Aimovig or Ajovy, and up to 6 months to see the full effects of Emgality. This is hardly ideal when you're experiencing debilitating migraines so frequently.^2-4

But for me the bigger problem with this was 2-fold: First, if I decided to go back into fertility treatment, the medication would have to be pulled immediately. This meant I might not ever even see the full effects and also potentially build immunity and not be able to try the medication again in the future.

Second, if I decided to go back into fertility treatments, I'd need to wait for the medication to leave my system. Again, with Aimovig and Emgality that could be up to 22 weeks/5.5 months, and with Ajovy it's still 1 to 2 months. This would require a significant amount of planning on my part around a set of decisions that are both very precarious AND require significant planning on their own.^2-4

How is Qulipta different?

With Qulipta, the medicine would work as soon as I took a dose (or a few), as it's a daily oral pill. Upon stopping it, the medicine would be out of my system within a few days to a week of stopping the medication. This came with so much more flexibility that I jumped at the opportunity.⁵

I'm now 16 months into my Qulipta journey (which may or may not be able to continue pending a new pharmacy and struggles with a new prior authorization). Along with Botox for migraines, this medication has mostly prevented any disastrous migraines. My use of abortive medications (Fioricet® and ketorolac IM injections) has decreased significantly, and overall my quality of life has improved due to the reduction of migraine days and severity.