Are CGRP injections safe for my migraines at 37?

Question

Hello doctor,

I am 37 years old and suffer from chronic migraines more than 20 days per month, which are severely affecting my quality of life. My neurologist has recommended trying migraine injection treatments with the newer CGRP medications such as Aimovig or Emgality.

I previously used Topiramate for prevention, but it caused significant cognitive side effects; I had trouble remembering words and frequently lost my train of thought. I also tried Propranolol, but it lowered my blood pressure too much, down to 88/52.

My migraines became much worse after I had an IUD placed six months ago, and I am wondering if hormonal changes could be triggering them.

I also have endometriosis, which causes severe pelvic pain, and my gynecologist believes the two conditions may be connected.

I use Sumatriptan for acute migraine attacks, but I am limited to using it only nine days per month, even though I need it much more often. I have missed a lot of work because of my migraines and am worried about losing my job.

The migraine injections are expensive, and my insurance requires that I fail three other preventive treatments before approving them.

Do these migraine injection treatments work for hormonal migraines?
Also, can they be used if I am planning to get pregnant next year?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com

I have read your query and understand your concerns.

Chronic migraine with a hormonal influence can be extremely disabling, especially when you have already tried several standard preventive treatments without success.

CGRP monoclonal antibody injections, such as Aimovig, Emgality, Ajovy, or Vyepti, are an excellent next option. These medications are specifically designed for chronic or treatment-resistant migraine.

They work by blocking the calcitonin gene–related peptide (CGRP) pathway, which plays a key role in migraine pain. Most patients experience fewer attacks, reduced severity, and shorter duration of migraines within two to three months of starting treatment.

These injections can also help hormone-related migraines, although the degree of benefit varies between individuals. Since your migraines worsened after IUD (intrauterine device) placement and you also have endometriosis, hormonal fluctuations are likely contributing to your symptoms.

Coordination between your neurologist and gynaecologist may help determine whether adjusting hormonal therapy could improve migraine control.

In terms of safety, CGRP injections are non-sedating, do not lower blood pressure, and generally have minimal side effects. Some patients may experience mild injection-site pain or constipation.

However, these medications have not yet been proven safe during pregnancy, so they are usually avoided and should be stopped several months before trying to conceive.

For now, continue using triptans for acute migraine relief, but keep total use under ten days per month to avoid medication-overuse (rebound) headaches.

Maintaining regular sleep, hydration, meals, and stress control is also very important, as these lifestyle factors strongly affect migraine frequency.

You may also discuss supplements such as vitamin D, magnesium, and riboflavin with your doctor, as they can be helpful for some patients.

Since your insurance requires prior preventive medication trials, ask your neurologist to clearly document your intolerance or failure with topiramate, propranolol, and at least one antidepressant such as Amitriptyline. This documentation can help you qualify for CGRP therapy coverage.

With the right combination of preventive treatment and hormonal balance, there is a strong possibility that your migraine control and overall quality of life can improve significantly.

I hope this information is helpful, and I would greatly appreciate your feedback.

Thanks and regards.