Aimovig alternatives: What can I take instead of Aimovig?

Compare Aimovig alternatives | Beta blockers | Antidepressants | Anticonvulsants | Calcium channel blockers | Other CGRP receptor antagonists | Natural alternatives | How to switch meds

Aimovig is an injectable drug approved to help prevent migraine headaches. It is a monoclonal antibody that belongs to a class of drugs known as calcitonin gene-related peptide receptor antagonists (CGRP). Aimovig is a once-monthly injection made by the manufacturer, Amgen. It is provided in an autoinjector device designed to be self-administered as a subcutaneous injection in the upper arm, abdomen, or thigh. Aimovig has been shown to significantly decrease the occurrence of migraines in patients who experience episodic or chronic migraines. There is no generic version of this medication.

CGRP receptor antagonists have been a welcomed addition to the treatment options for migraine sufferers. Approximately 12% of the population suffers from migraines, and they are more common in women. Migraines negatively affect activities of daily living and are not just limited to pain in the head. Nausea, light sensitivity, and sound sensitivity typically accompany migraines. For many, migraines are a chronic condition with symptoms that present 15 or more migraine days each month. 

CGRP is a peptide whose concentrations go up during migraine attacks. For chronic sufferers, CGRP is believed to remain elevated. CGRP is responsible for pain signal transmission and also plays a role in vasodilation, two key components of migraines. Aimovig works by binding to the CGRP receptor and blocking the effects of CGRP. This reduces pain transmission and reverses vasodilation. Aimovig is only approved by the U.S. Food and Drug Administration (FDA) for the prophylaxis (prevention) of migraines. Other CGRP antagonists may be FDA-approved for both prevention and treatment. Aimovig is not a first-line treatment for migraines. CGRP antagonists are appropriate only once other treatment options have been proven ineffective. Aimovig can cause some side effects, which may not be desirable. Constipation was the most frequently reported adverse event in initial clinical trials, and in some cases, it was severe. Other side effects included muscle cramps, muscle spasms, and musculoskeletal pain. Hypersensitivity or allergic reactions to erenumab, as well as injection site reactions, may also occur.

Aimovig may not be the right choice for all migraine patients. Factors such as the efficacy of other treatments, side effects, cost, and insurance coverage may lead you to look for alternative options to Aimovig. Luckily, there are other options for prevention or treatment of migraines.

RELATED: What is migraine? Your guide to talking about the condition

What can I take in place of Aimovig?

There are a variety of approaches to migraine therapy and preventative treatment. Aimovig is specifically approved for the prevention of migraines. Other drug classes that have been used for prevention successfully include beta blockers, antidepressants, anticonvulsants, calcium channel blockers, and other CGRP antagonists. If you need treatment options for migraines once they occur, other drugs are more appropriate than Aimovig. These can include over-the-counter pain relievers, nonsteroidal antiinflammatories, triptans, or CGRP antagonists approved for treatment. Listed below are some alternatives to Aimovig. This is not intended to be medical advice, but it is intended to be informative and provide some options you can discuss with your healthcare provider.

Other alternatives to Aimovig

• Qulipta (atogepant)
• Nurtec ODT (rimegepant)
• Ubrelvy (ubrogepant)
• Zavzpret (zavegepant)
• Tylenol (acetaminophen)
• Aleve or Naprosyn (naproxen)
• Relpax (eletriptan)
• Frova (frovatriptan)
• Amerge (almotriptan)
• Maxalt (rizatriptan)

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Top 5 Aimovig alternatives

The following are some of the most common alternatives to Aimovig.

1. Beta Blockers

Beta blockers have an important place in the list of options to prevent or decrease the occurrence of migraines. Beta blockers play a role in regulating vasodilation. This helps to prevent drastic changes to the dilation of blood vessels, a common etiology of migraines and other types of headaches. Beta blockers are oral medications taken once a day and are generally very cost-effective compared to CGRP antagonists. They may take up to 12 weeks to be fully effective. The most common side effects of beta blockers can include fatigue, nausea, dizziness, and depression. Beta blockers may be preferred in migraine sufferers who also have underlying cardiovascular disease or hypertension (high blood pressure).

Examples: Toprol XL (metoprolol), Inderal LA (propranolol), Tenormin (atenolol)

2. Antidepressants

The use of antidepressants for migraine prevention is off-label but has shown benefit in many migraine sufferers and patients with other types of chronic headaches. Antidepressants work to allow more free serotonin in the nervous system, and low serotonin is suspected to play a role in migraines for some. By increasing serotonin levels, migraines have been known to decrease in severity and occurrence. Patients can see benefits in four weeks, making them beneficial in a shorter time than beta blockers. Antidepressants are oral medications, and many are generic and relatively affordable. Side effects may include drowsiness, weight gain, dizziness, and dry mouth. Antidepressants are not an acceptable option for patients who take monoamine oxidase inhibitor drugs (MAOIs).

Examples: Elavil (amitriptyline), Effexor XR (venlafaxine), Prozac (fluoxetine)

3. Anticonvulsants

Anticonvulsants have also been used in migraine prevention, and Topamax (topiramate) is considered a first-line treatment option. It can take eight to 12 weeks for it to show benefits. The mechanism by which anticonvulsants prevent migraines is not entirely defined but likely is a component of their actions in the central nervous system. Anticonvulsants can cause memory or concentration problems, drowsiness, fatigue, and nausea. Topamax also decreases appetite. These are oral medications that are available generically in most cases. Patients who are breastfeeding, pregnant, diabetic, have a history of kidney stones, or have a history of glaucoma should speak to their prescriber before starting anticonvulsants.

Examples: Topamax (topiramate), Depakote (divalproex), Neurontin (gabapentin)

4. Calcium Channel Blockers

Calcium channel blockers do not have as much supporting evidence in migraine prevention as the drug classes discussed above. However, if other factors or choices that limit your options have been unsuccessful, your prescriber may consider calcium channel blockers. Calcium channel blockers are antihypertensive medications and can cause dizziness and fatigue as adverse effects. 

Examples: Verelan (verapamil), Adalat (nifedipine)

5. Other CGRP Receptor Antagonists

Choosing another CGRP antagonist may be a good option. Some CGRP receptor antagonists are dosed less frequently than Aimovig (every 3 months versus every month), which may be desirable for some. Some insurance formularies may make one drug in the class significantly more affordable than others, which could change the preferred formulary product. Finally, some CGRP antagonists are indicated for the prevention and treatment of migraines, and dual approval may be preferred for some.

Examples: Vyepti (eptinezumab), Ajovy (fremanezumab), Emgality (galcanezumab)

Natural alternatives to Aimovig

The American Academy of Neurology has endorsed the use of the herbal supplement butterbur for migraine prevention. Other supplements, such as feverfew, magnesium, vitamin B2, and coenzyme Q10, have been used for migraine prevention but have little data to support their efficacy. While you may have heard of Botox being utilized in migraines, it has limited data to support its use in migraine prophylaxis.

Practitioners recommend learning to recognize the triggers of migraines and avoiding those triggers whenever possible. Keeping a migraine journal or diary will help track commonalities between migraine occurrences and help you understand triggers better. There may be benefits to non-pharmacological treatments such as acupuncture, massage, and cognitive behavioral therapy.

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How to switch to an Aimovig alternative

If you are considering an Aimovig alternative, be prepared to speak to your prescriber about the reasons driving you to consider change. Consult a pharmacist or your insurance plan representative to understand each choice’s financial implications better. Some manufacturers may also offer assistance programs that can lower your out-of-pocket cost or copay. If your concerns are related to adverse events, make sure to share those with your prescriber. It is important to have a complete list of other medications and medical conditions your prescriber should consider. Do not stop taking your current therapy without consulting your prescriber first.