Aimovig (erenumab) offers a targeted approach to migraine prevention in the USA. This monthly injection can significantly reduce the frequency of migraine attacks for eligible adults.  

For millions of Americans living with migraine, a condition characterized by severe headaches often accompanied by throbbing pain, nausea, vomiting, and extreme sensitivity to light and sound, prevention is key to reclaiming their lives.

Before 2018, preventive treatments for migraine were largely medications repurposed from other conditions (like antidepressants, anti-seizure drugs, or blood pressure medications) that often came with bothersome side effects and limited efficacy. The introduction of Aimovig (erenumab), marketed by Amgen, marked a groundbreaking shift, becoming the first FDA-approved medication specifically designed to prevent migraine attacks in adults by targeting a novel pathway.  

Understanding Aimovig: A CGRP Receptor Blocker

Aimovig is a biologic medication, specifically a human monoclonal antibody, that targets the calcitonin gene-related peptide (CGRP) receptor. CGRP is a naturally occurring neuropeptide that plays a crucial role in initiating and sustaining migraine attacks. During a migraine, CGRP levels are elevated, contributing to pain transmission and inflammation in the brain.  

Here's how Aimovig works:

• Blocking the Receptor: Rather than targeting the CGRP molecule itself, Aimovig works by binding to and blocking the CGRP receptor. Imagine the CGRP receptor as a lock and CGRP as the key. Aimovig acts as a blocker that fits into the lock, preventing the CGRP key from turning it.  
• Preventing Pain Signals: By preventing CGRP from binding to its receptor, Aimovig effectively stops the pain signals and inflammatory processes that CGRP would otherwise activate, thereby preventing migraine attacks before they even start. This highly targeted mechanism makes Aimovig a specific and effective preventive treatment.  

Indications and Administration in the USA

In the USA, Aimovig is FDA-approved for the preventive treatment of migraine in adults. It is used for both episodic migraine (fewer than 15 headache days per month) and chronic migraine (15 or more headache days per month).  

A key advantage of Aimovig is its convenient administration. It is given as a subcutaneous injection (under the skin), typically once per month. Patients can learn to self-administer the injection at home using a prefilled SureClick® autoinjector or a prefilled syringe, providing a high degree of independence and flexibility. Aimovig is available in two doses: 70 mg and 140 mg, with a healthcare provider determining the appropriate dose for each individual.  

Efficacy of Aimovig in Migraine Prevention

Clinical trials have demonstrated Aimovig's significant efficacy in reducing the frequency of migraine days for many patients. Key findings include:  

• Reduction in Monthly Migraine Days: Patients treated with Aimovig experienced a significant reduction in their average monthly migraine days compared to placebo. Many individuals saw their migraine days cut in half or more.  
• Responder Rates: A notable percentage of patients achieved at least a 50% reduction in monthly migraine days.  
• Improved Quality of Life: Beyond just reducing migraine frequency, patients reported improvements in daily functioning, reduced use of acute migraine medications, and overall better quality of life.  
• Sustained Efficacy: The benefits of Aimovig have been shown to be sustained over long-term treatment.

Important Considerations and Potential Side Effects

While Aimovig is generally well-tolerated, like all medications, it can have potential side effects:

• Common Side Effects: The most common side effects reported are injection site reactions (such as pain, redness, or swelling at the injection site) and constipation. Muscle cramps or spasms and flu-like symptoms may also occur. Injection site reactions are usually mild and temporary.  
• Serious Side Effects (Rare but Important):
  • Allergic Reactions: Serious hypersensitivity reactions, including rash, swelling (angioedema), and even anaphylaxis, have been reported. These can occur within hours to more than a week after administration.  
  • Severe Constipation: While mild constipation is common, severe constipation, sometimes requiring hospitalization or surgery, has been reported. This usually occurs after the first dose but can happen later in treatment.  
  • High Blood Pressure: New onset or worsening of pre-existing hypertension has been reported. Monitoring blood pressure, especially early in treatment, is advisable.  
  • Raynaud's Phenomenon: Worsening or new onset of this circulation problem, characterized by numbness, coolness, or color changes in fingers and toes, has been reported.  

It's crucial for patients to discuss their full medical history with their healthcare provider before starting Aimovig, especially if they have pre-existing cardiovascular conditions, high blood pressure, or a history of severe constipation.

Cost and Access in the USA

As a brand-name biologic medication, Aimovig can be expensive. The list price for a monthly dose in the USA can be over $500-$600. However, most patients in the USA do not pay the full list price.

• Insurance Coverage: Most commercial insurance plans, Medicare Part D, and some Medicaid plans provide coverage for Aimovig. However, prior authorization is almost always required, and specific coverage criteria (e.g., trying and failing other preventive medications first) vary by plan.  
• Manufacturer Savings Programs: Amgen, the manufacturer of Aimovig, offers a co-pay card program for eligible commercially insured patients. This program can significantly reduce out-of-pocket costs, potentially to as little as $5 per month for some individuals. Patient assistance programs are also available for uninsured or underinsured patients who meet specific eligibility criteria.  
• Pharmacy Discount Programs: While less impactful for high-cost biologics, some pharmacy discount cards or programs might offer a modest reduction in cash price.

Aimovig represents a significant leap forward in migraine prevention, offering a targeted, effective, and generally well-tolerated option for many adults who previously struggled to find adequate relief. For individuals in the USA whose lives are significantly impacted by frequent migraines, Aimovig provides a valuable pathway to reducing migraine days and improving their overall quality of life.