Injection or Pill?

If your doctor gave you the option of an effective injection over your over-the-counter Excedrin to treat your migraine? What about even as a preventative for episodic migraines?

As of June 4th, 2019, the U.S. Food and Drug Administration (FDA) approved Emgality drug for both treatment and preventative measures for episodic migraines. An episodic migraine can be characterized by patients who experience zero to fourteen migraines a month, becoming chronic after reaching fifteen or more migraines per month. Though if you were to ask any individual that has experiences a full blown migraine, they could easily argue that more than one a month is painful enough. Each migraine begins with a unique personal trigger (maybe a woman’s mensural cycle, the weather changing, stress, smell, etc.) for each individual experiencing one. This trigger sends a signal to the brain that then prompts blood vessels in your brain to swell, nerve fibers coiled around blood vessels to release chemicals to instigate pain and inflammation. And before the Excedrin bottle could even be opened sometimes, ‘central sensitization’ has now developed spread along nerve pathways from your head to your neck and spine. The vicious and fretted migraine has already began.

But now doctors, researchers, and drug developers are able to prescribe a medication that can stop this cascade of unfortunate events from unfolding. Emgality uses the power of monoclonal antibodies to treat migraine victims, like many other drugs utilized for diseases such as cancer. Monoclonal antibodies are created in a laboratory and sometimes grown in other species such as mice or rabbit. These test species are used to synthesize immune system proteins that make up monoclonal antibodies. Once secreted, these engineered molecules can substitute antibodies within the patients body to enhance, mimic or restore immune system function. The monoclonal antibodies can be made to have a variety of functions, most commonly to aid the immune system in recognition of harmful foreign cells that proper T cells and the alike may destroy. Though for Emgality, or galcanezumab-gnlm, holds a humanized IgG4 monoclonal antibody for specifically calcitonin-gene related peptide (CGRP) ligand and made from hamster ovary cells after recombinant DNA technology.

Through humanized IgG4 monoclonal antibody being present, it works as an antagonist of certain proteins thought to trigger and cause episodic migraines. The injection of the drug prompts a negative immune response by blocking the binding sites on the CGRP receptor. Later studies have found it to have numerous cellular targets for migraine therapy, affecting the function of vascular smooth muscle cells, mast cells, glial cells, neurons in the CNS and more. All of which are involved with the unfolding of a migraine. Most importantly though it inhibits the CGRP receptors on dural mast cells that would typically prompt mast cell degranulation, histamine release and other pro-inflammatory agents that cause the peripheral sensitization during a migraine. Which would typically cause immense pain for an individual during a migraine if the CGRP receptor was not blocked by this antagonist.

Adults with reported episodic migraines are the encompassed demographic for Emgality. A patient who falls within this demographic is able to receive and later administer Emgality injections on themselves. Two consecutive injections totally 240 mg of Emgality are required as a loading dose, along with monthly 120 mg injections. Side effects of Emgality include:

(At the site of injection)

• redness
• itchiness
• pain
• tenderness

Most patients experience mild and short lasting side effects at the site of injection, which are very common given the administration method of the drug. Though serious side affects that are not as common include:

• skin rash
• itchiness
• flushing in the face and neck (skin warmth and redness)
• allergic reaction
  • swelling under the skin, in eyelids, lips, hands or feet
  • swelling of the tongue, mouth or throat
  • trouble breathing
• fatigue
• respiratory tract infection
• back pain
• sore throat
• sinus infection

Given these possible side effects in relation to the episodic migraine treatment and prevention Emgality is used for, these side effects seem common compared to other recently released or even commonly taken drugs. Therefore, if an individual suffered from migraines sometimes fourteen out of the thirty-ish days of a single month, Emgality may be worth a try.

One thing that is very serious for both doctors and their patients to be careful about is the chance of an allergic reaction. There have been contraindications in patients with hypersensitivity to galcanezumab-gnlm (the monoclonal antibody used in Emgality) or any of its substituents.

With also a very small percentage of test patients during trials that had an immune reaction where they developed antibodies against Emgality itself. Individuals with this issue are unable to use the drug given that it does not work for them once the antibodies against the engineered antibodies are created–funny how our immune systems work sometimes, right?

Once carefully testing for hypersensitivity or tentatively trying Emgality while being attentive to how your body responds, it can be a drug that outweighs common side effects and grants individuals their regular lives back. Migraine free.