Are CGRP shots effective during period migraines?

Question

Hello doctor,

I am 34 and have been dealing with chronic migraines for years. After trying various oral preventive medications without success, I recently started monthly Fremanezumab injections.

I also experience heavy menstrual bleeding and have low ferritin levels (18 ng/mL). I have noticed that my migraines often worsen around my period.

I have a few questions:

Are CGRP inhibitors like Fremanezumab still effective during hormonal migraine flares, or should they be combined with another treatment during that time?
Are there any long-term side effects or risks of developing resistance with the continued use of these injections?
I had weight gain with previous medications; does Fremanezumab carry a similar risk?

Thank you for your time and guidance.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

You are taking all the proper steps by considering what to do next after starting Fremanezumab, especially given your history of chronic migraines, which are frequent and intense headaches that occur 15 or more days each month, along with hormone-related flares.

To address your concerns:

CGRP (calcitonin gene-related peptide) inhibitors like Fremanezumab remain effective during menstrual migraines, but they may not completely prevent hormone-triggered attacks in everyone. This is because hormonal fluctuations, especially the drop in estrogen before your period, are powerful migraine triggers. While CGRP blockers lower the brain's overall migraine activity, some individuals may still need additional support during hormonally sensitive times.
Fremanezumab is generally safe for long-term use. There is no known risk of liver, kidney, or immune system damage, and routine blood tests are not typically required unless another medical issue is present. Resistance or loss of effect over time is rare, and most patients continue to experience consistent relief.
Side effects are usually mild and may include constipation, injection site reactions, or, rarely, allergic responses. If you notice that the medication starts to "wear off" before your next dose, options like switching to a quarterly injection schedule or adjusting your acute migraine treatment may help.
Fremanezumab is not linked to weight gain. Unlike certain oral preventives (such as Valproate, Amitriptyline, or beta-blockers), it is weight-neutral; it does not increase your appetite or cause fluid retention. If weight gain was an issue with your previous medications, Fremanezumab is a much safer option in that regard.

Kindly consult your doctor and take medicines accordingly.

I hope this helps.

Please revert in case of further queries.

Thank you.