This document summarizes several monoclonal antibodies approved or in development for preventing migraines by targeting calcitonin gene-related peptide (CGRP). Three antibodies have been approved by the FDA to prevent migraines in adults: erenumab, fremanezumab, and galcanezumab. Eptinezumab is a humanized antibody targeting CGRP that has shown positive results in phase 3 trials for migraine prevention. The document also includes a Migraine Disability Assessment Scale questionnaire to help physicians understand the impact of a patient's headaches.

1. CGRP: calcitonin gene-related peptide.
1. https://pi.amgen.com/~/media/amgen/repositorysites/pi-amgen-com/Aimovig/Aimovig_pi_hcp_english.pdf. Accessed October 3, 2018. 2. https://www.ajovyhcp.com/globalassets/ajovy/ajovy-pi.pdf. Accessed October 3, 2018.
3. http://pi.lilly.com/us/emgality-uspi.pdf. Accessed October 3, 2018. 4. Saper J et al. 70th Annual Meeting of the American Academy of Neurology (AAN 2018). Abstract S20.001. 5. Kudrow DB et al. AAN 2018. Abstract P4.470.
This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
Approved and Emerging
Anti-CGRP Monoclonal Antibodies
for Migraine Prevention
PRACTICE AID
Access the activity,“Exploring the Latest Evidence on New and Emerging Therapies for Migraine Prevention:
What Are the Potential Implications on Clinical Practice?”at www.peerview.com/EJR40.
Antibody type: humanized
Directed against: CGRP ligand
Indication: preventive treatment of migraine in adults
Recommended dosage: 240 mg subQ loading dose,
administered as two consecutive injections of 120 mg
each, followed by monthly doses of 120 mg
Galcanezumab-gnlm3
Antibody type: humanized
Directed against: CGRP ligand
Indication: preventive treatment of migraine in adults
Recommended dosage: 225 mg subQ once a month or
675 mg subQ once every 3 months, administered as
three consecutive injections of 225 mg each
Fremanezumab-fvrm2
Erenumab-aooe1
Antibody type: fully human
Directed against: CGRP receptor
Indication: preventive treatment of migraine in adults
Recommended dosage: 70 mg subQ once a month;
some patients may benefit from 140 mg subQ once a
month, administered as two consecutive injections of
70 mg each
Approved Anti-CGRP
Monoclonal Antibodies
Emerging Anti-CGRP
Monoclonal Antibody
Antibody type: humanized
Directed against: CGRP ligand
Positive data from phase 3 migraine prevention
trials have been reported
Eptinezumab4,5

2. Access the activity,“Exploring the Latest Evidence on New and Emerging
Therapies for Migraine Prevention: What Are the Potential Implications on
Clinical Practice?”at www.peerview.com/EJR40.
Migraine Disability
Assessment Scale (MIDAS)1,2
PRACTICE AID
This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
1. Stewart WF et al. Neurology. 2001;56(6 Suppl 1):S20-S28. 2. Stewart WF et al. Headache. 2003;43:258-265.
Question Days
1. On how many days in the last 3 months did you miss school or work because of
your headaches?
2. How many days in the last 3 months was your productivity at work or school reduced
by half or more because of your headaches? (Do not include days you counted in the
first question.)
3. On how many days in the last 3 months did you not do household work (such as
housework, home repairs and maintenance, shopping, caring for children and relatives)
because of your headaches?
4. How many days in the last 3 months was your productivity in household work reduced
by half or more because of your headaches? (Do not include days you counted in the
third question where you did not do household work.)
5. On how many days in the last 3 months did you miss family, social, and/or leisure
activities because of your headaches?
Total (Questions 1-5)
Please answer the following questions about ALL of the headaches you have had
over the last 3 months. Select your answer in the box next to each question;
choose zero if you did not have any activity in the last 3 months.
A. On how many days in the last 3 months did you have a headache? (If a headache
lasted more than 1 day, count each day.)
B. On a scale of 0 to 10, on average how painful were these headaches? (0 = no pain
at all; 10 = pain as bad as it can be)
What your
physician
needs to
know about
your headaches
MIDAS Grade Definition MIDAS Score
I Little to no disability 0-5
II Mild disability 6-10
III Moderate disability 11-20
IV Severe disability 21+
If your MIDAS score is 6 or more,
please discuss this with your doctor.
QuestionnaireScoring