Do CGRP injections treat my chronic migraine?

Question

Hello doctor,

I am 42 and have been suffering from chronic migraines for over 10 years, but they have gotten significantly worse in the past two years. I am having severe headaches 20 to 25 days per month that are completely debilitating. The pain is so intense that I vomit and have to lie in a dark room for hours while my life falls apart around me. I am a single mother of twin 12-year-olds, and I feel like I am failing them because I am constantly sick.

I have tried every preventive medication. Topiramate made me feel confused and depressed, Propranolol dropped my blood pressure too low, and Amitriptyline caused terrible weight gain. Triptans do not work anymore, and I am worried about rebound headaches from overuse.

My neurologist mentioned the new CGRP injections like Erenumab and Galcanezumab, but my insurance denied coverage, saying they are “experimental.” The appeal process is taking months while I continue to suffer. I have had to take so much time off work that my job is in jeopardy. My children are acting out at school, and I know it is because their mother is always in pain and unavailable.

What is the difference between all these new migraine injections?
Are there patient assistance programs to help with the cost?
I am also interested in Botox treatments, but I am wondering if insurance covers that, either?

I am desperate for anything that will give me my life back.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

You are dealing with chronic migraine, and it is a condition that significantly affects quality of life, especially when you are also juggling parenting and work.

The frequency and severity of your attacks, along with your limited response or adverse effects to conventional preventive medications, make you a strong candidate for newer therapies. You have tried:

Topiramate.
Propranolol.
Amitriptyline.

Newer therapies include calcitonin gene-related peptide monoclonal antibodies (CGRP monoclonal antibodies). These include:

Erenumab.
Galcanezumab.
Fremanezumab.
Eptinezumab.

While they work slightly differently in terms of administration and target (some block the calcitonin gene-related peptide receptor, and others block the calcitonin gene-related peptide molecule), all have shown good results in reducing migraine frequency and severity.

It is unfortunate that insurance companies are labeling these as experimental, even though they have been approved by the Food and Drug Administration (FDA) and are now widely used. While you are navigating the appeal process, check whether the manufacturers offer patient assistance programs. Many have income-based support options that could provide the medication for free or at a reduced cost.

As for OnabotulinumtoxinA, it is approved by the Food and Drug Administration (FDA) for chronic migraine prevention and is often covered by insurance when documented properly. It is administered every 12 weeks and has helped many patients who have not responded to other treatments.

I hope you are satisfied with my answer. For any further queries, you can contact me on iCliniq.

Thank you.

Do CGRP injections treat my chronic migraine?

Considering CGRP injections or Botox for chronic migraine?