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What is CGRP (calcitonin gene related protein)?
Aimovig®
Ajovy®
Ajovy is a monoclonal antibody that targets the CGRP neuropeptide itself. If was the first of three monoclonal antibodies targeting CGRP approved by the FDA (September 2018) and the first time the drug was presented to physicians post approval was at the Southern Headache Society conference in 2018. It was not found to cause constipation. The drug was proven to work in chronic migraine given 3 shots every 3 months. In episodic migraine the dose proven to work was one shot per month or three shots given every 3 months. For chronic migraine, 1 shot each month was never tested for prevention. Despite this, 1 shot per month is the most common dosing schedule used for Ajovy for chronic migraine.
Emgality®
Emgality is a monoclonal antibody that targets the CGRP neuropeptide and was the 2nd drug of this type that was FDA approved to prevent migraine headaches. The dosing of this medication for migraine is 2 – 120 mg shots to start treatment and then 1 shot each month. The same dose is used for both chronic migraine and episodic migraine.
Vyepti®
Vyepti is a monoclonal antibody that targets the CGRP neuropeptide and was the 3rd drug of this type approved by the FDA. It is given intravenously to patients every 3 months. Two doses are approved, both 100 mg every 3 months and 300 mg every 3 months. Because it is intravenous, it is not associated with any local shot reaction.
Nurtec®
Nurtec is an oral CGRP receptor blocker that was FDA approved to treat acute migraine when it was approved for use as a migraine preventative. It therefore because the only drug ever approved for both acute migraine treatment and migraine prevention. For prevention, it is given every other day. Like Aimovig®, it is associated with constipation but the constipation rate is lower than Aimovig® presumably because it is given every other day. This drug works best for constipation when patients have another acute medication to take for headaches that occur on days that Nurtec is not scheduled to be taken.
Qulipta®
Qulipta is an oral CGRP receptor blocker that has been demonstrated to prevent migraine in both episodic migraine and chronic migraine. It comes in 3 doses, 10 mg, 30 mg, and 60 mg. The lowest dose is really designed so one can use it if the patient is on a drug that slows the metabolism of the medication. 30 mg and 60 mg are the more commonly used doses for migraine prevention. Constipation is the primary negative side effect.
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Tabitha H.(Patient Since 2017)
I have suffered with migraines since 2012. Not just any migraines severe, debilitating migraines . I would be bedridden for days, weeks and at one point even months. I have been to doctors all over Louisiana and Texas since the end of 2012. I finally started going to a neuro-ophthalmologist in the Houston area in either 2015 or 16. ( Dr. Rosa Tang ) She was treating me for another health problem that I have been suffering with since 2012 as well. When I gave her my medical history I told her about my migraines. They would be so severe at times that I would get migraines in my eyes and it would feel like someone was stabbing me with a knife in my eyes. I would also get extremely nauseated and have even thrown up on several occasions due to the severity of my migraines. Dr. Tang referred me to Dr. Loftus sometime around the beginning of 2017. Honestly, I thought why? I’ve been to all these other doctors and had very little hope that he would be able to help me. I met with Dr. Loftus and he was very thorough. He stayed in the room with me asking questions for at least 20 minutes. He started me on a new medicine and did treatment on me that day. From that day forward my migraines have gotten so much better. I’m slowly getting my life back. We have had to adjust my medicine a couple of times. But I can tell a huge difference since I began going there. Yes, I still do get migraines however, they are nowhere near as severe as they used to be. I can function so much better now since Dr Loftus has been training me. He doesn’t just throw his hands up in the air and say I don’t know how to help you, he keeps trying new things until he finds a solution. He is phenomenal, his staff is great and I’m so thankful that God made a way and lead me to his office. I highly, highly recommend him if anyone out there has had their life stolen from them by migraines.
Kathy T.(Patient Since 2017)
For 20+ years I have been told I have Migraines, which was amended to chronic cluster headaches. I have taken numerous medications, given myself shots, applied diets free of caffeine and chocolate, had sinus and neck surgeries, acupuncture, cortisone shots in my head, MRI’s, CAT scans, not to mention all countless visits to the ER, all to no avail. Within 10 minutes speaking with Dr Loftus, he informed me that I had been misdiagnosed all these years, he knew what was wrong, and he has a game plan to help me. I feel extremely confident in his diagnosis and believe I may actually be going in the right direction for once! Thank you so very much Doc, you ROCK! Fingers crossed that he is correct and I will finally have some relief…
Providing headache and hyperhidrosis care & wellness for over 25 years.
Dr. Brian Loftus, M.D.
Dr. Loftus is Board Certified in Headache Medicine as well as Neurology. In private practice since 1994, Dr. Loftus’ practice has gotten busier and he has decided to concentrate his practice in areas that he can make a particular difference compared to other neurologist. Therefore, Dr. Loftus has chosen to focus his neurology practice on headaches & head pain, headaches during pregnancy, and hyperhidrosis. In the spring of 2006, Dr. Loftus relocated his practice from the Texas Medical Center to Bellaire, just 5 miles west. He has been named a Texas Monthly “Super Doctor” and an H Texas magazine “Top Doctor” multiple times.