Erenumab (Aimovig®): A Monthly Injectable to Prevent Migraine

Erenumab (Aimovig®): The first monthly injectable migraine preventive

Erenumab (Aimovig®) is the first CGRP monoclonal antibody approved to prevent migraine. It is given subcutaneously once every month using an auto-injector. It is the only CGRP monoclonal antibody that targets the CGRP receptor.

Looking for a detailed medication handout of Aimovig®? Explore our downloadable handouts created by the specialists at the Ottawa Headache Centre.

How to access erenumab (Aimovig®) in Ottawa

Erenumab (Aimovig®) is used for the prevention of episodic or chronic migraine. It is administered with an auto-injector similar to an epinephrine-pen. It is self-injected once a month.

We consider erenumab (Aimovig®) when:

Patients continue to have frequent migraine attacks after trying two oral preventives
Pregnancy is not foreseeable for at least 6 months
There is a preference for infrequent dosing rather than taking a medication every day
There is a preference for a self-administered medication at home rather than an intravenous treatment
Multiple other CGRP antagonists have failed and we wish to block the CGRP receptor directly

How do you access erenumab (Aimovig®) in Ottawa?

In Ontario, coverage for erenumab (Aimovig®) often requires:

A diagnosis of episodic or chronic migraine
Documentation of migraine frequency
Trials of at least two oral preventive medications at therapeutic doses (usually for ~3 months each, depending on insurer)

Unlike the other CGRP antagonists, erenumab (Aimovig®) is not available for reimbursement through the Exceptional Access Program.

We assist with:

Insurance forms
Prior authorization

At the Ottawa Headache Centre we will:

Confirm your diagnosis and migraine burden
Determine whether erenumab (Aimovig®) is an appropriate option, and offer alternatives
Discuss the evidence backing erenumab (Aimovig®), its benefits, as well as side-effects
Assist with any insurance forms
Complete the prior authorization process that is needed

Next steps to get started on erenumab (Aimovig®) in Ottawa

If you feel like you are getting nowhere with your migraine preventives, ask your doctor for a referral to the Ottawa Headache Centre and we will explore migraine-specific preventive options with you.

How does erenumab (Aimovig®) prevent migraine

Unlike other CGRP antibodies, erenumab (Aimovig®) blocks the CGRP receptor directly, preventing CGRP from transmitting pain signals.

By reducing CGRP activity, erenumab (Aimovig®):

Lowers the likelihood that a migraine attack will occur.

Decreases the severity and duration of migraine attacks.

Makes migraine attacks more susceptible to acute medications (i.e., easier to treat).

Next steps

Erenumab (Aimovig®) was the first approved CGRP antagonist, and continues to have a selective role in migraine prevention. Determining whether it is the right migraine-specific preventive for you depends on your diagnosis, migraine pattern, prior treatment history, preferences, and lifestyle values.

If you are considering Aimovig® (or have been referred), our consultation helps:

confirm whether erenumab (Aimovig®) fits your migraine profile
set realistic timelines for judging response
and place it into a broader, individualized care plan (including acute and non-medication strategies).

Ask your doctor for a referral to the Ottawa Headache Centre if you want to learn more about your migraine-specific preventive options.

Common questions about erenumab (Aimovig®)

What are the side effects of erenumab (Aimovig®)?

Erenumab (Aimovig®) is generally well tolerated.

Possible side effects:

Constipation can be significant for some people
Injection-site reactions (redness, soreness)
Muscle or joint aches
Fatigue (uncommon)
Urinary tract infections or nasopharyngitis (rare)

Serious allergic reactions are rare.

Does erenumab (Aimovig®) affect the immune system?

No.
Erenumab (Aimovig®):

Does not suppress the immune system
Does not increase infection risk
Is not considered an immunosuppressive therapy

Can erenumab (Aimovig®) be used during pregnancy?

CGRP monoclonal antibodies including erenumab (Aimovig®) are not recommended during pregnancy due to limited safety data.

If pregnancy is planned:

These medications should be stopped at least 6 months before pregnancy

This allows time for the medication to fully clear from the body.

If you are pregnant or planning pregnancy, we will help you find alternative migraine strategies.

Can erenumab (Aimovig®) be used during breastfeeding or lactation?

Data on breastfeeding are limited but growing, and expert consensus is that CGRP monoclonal antibodies' expression in breast-milk is low, the amount of drug an infant may consume and ultimately absorb is trivial. Decisions are individualized based on:

Migraine severity
Available alternatives
Patient preferences

We help guide these discussions using the best available evidence.

Can erenumab (Aimovig®) be combined with other treatments?

From a medical perspective, erenumab (Aimovig®) can be used:

Alone
Alongside other oral preventive medications
Concurrently with Botox® for chronic migraine, although insurers will typically not cover both

Insurance plans may restrict coverage of combination advanced therapies.

Can gepants be combined with erenumab (Aimovig®)?

From a medical perspective, it is safe to combine erenumab (Aimovig®) and gepants although the combination may increase the risk of constipation.

Insurance plans may restrict coverage of combining a preventive gepant - like atogepant (Qulipta ®) and CGRP monoclonal antibodies..

What happens if erenumab (Aimovig®) works?

If erenumab (Aimovig®) is effective:

Treatment is continued
There is no monitoring required
Many patients can transition prescription renewal to their family physician
Treatment may be discontinued 1-2 years later to revaluate whether it needs to be continued

If I did not respond to one CGRP antagonist, does that mean that I won't respond to any?

No.

For many people it takes a few trials to find the most effective migraine preventive, and some people who have not responded to one CGRP antagonist respond to a different one. It is not uncommon to cycle through different treatment options until we find the one that is right for you.

Disclaimer

This material is provided for educational purposes and does not replace independent clinical judgment or institutional protocols. Management decisions remain the responsibility of the treating clinician.

Page updated

Google Sites

Report abuse