Can a person with migraines safely try CGRP injections?

Question

Hello doctor,

I am 52 and get migraine attacks that mimic a stroke, with numbness and vision loss. Can someone at 52 with stroke-like migraine symptoms safely try CGRP injectables?

I have failed triptans and preventive medications already.

Are CGRP injections risky with my neurological symptoms?
Could they actually reduce these scary attacks?

Every episode sends me to the ER, and it is exhausting. I am terrified of missing a real stroke one day.

I want relief, but I do not want to make things worse. I just need to know if this option is safe for someone like me.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

Migraine attacks (a severe attack that lasts from 4 to 72 hours) that cause numbness, vision loss, or other stroke-like symptoms are frightening, and it is completely understandable to feel anxious every time an episode occurs.

At age 52, it is especially important that any new or changing neurological symptoms are evaluated carefully because, while migraine with aura can closely mimic a stroke, a real stroke or transient ischemic attack must not be overlooked.

The newer CGRP (calcitonin gene-related peptide)-targeted medications, including Erenumab, Fremanezumab, Galcanezumab, and Eptinezumab, are generally considered effective and well-tolerated for preventing migraine in many people who have not responded to older preventive treatments.

Unlike triptans, they do not cause blood vessel constriction, which is one reason they may be an option for some patients who cannot use triptans.

However, people with migraines that include motor weakness, such as hemiplegic migraine (a type of migraine with one-sided paralysis and muscle weakness), or other unusual neurological symptoms, were often underrepresented in the original clinical trials, so the decision to use these medications should be individualized by a neurologist who is confident of the diagnosis.

If your episodes have been thoroughly evaluated and your neurologist has determined they are migraine with aura rather than strokes or another neurological disorder, a CGRP monoclonal antibody may reduce the frequency and severity of attacks.

Many patients experience fewer migraine days over the first one to three months of treatment, although responses vary, and not everyone improves.

Because you are 52 and have attacks that resemble a stroke, it is essential that you continue to treat any episode that is different from your usual pattern as a potential emergency.

If you develop new symptoms, symptoms that last longer than your typical aura, persistent weakness, difficulty speaking, severe imbalance, or the sudden worst headache of your life, you should seek emergency medical care immediately rather than assuming it is another migraine.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.