AHFS Class:

• Calcitonin Gene-related Peptide (CGRP) Antagonists 28:32.12

Generic Name(s):

• Erenumab

Erenumab-aooe, a recombinant fully human immunoglobulin G₂ (IgG₂) monoclonal antibody that targets the calcitonin gene-related peptide (CGRP) receptor, is an antimigraine agent.1,4,8,9,11

Preventive Treatment of Migraine

Erenumab-aooe is used for the preventive treatment of migraine in adults.1,2,3,4,7 In clinical studies, erenumab prophylaxis substantially reduced monthly migraine days and use of acute migraine-specific medication in patients with episodic or chronic migraine compared with placebo.1,2,3,4

Clinical Experience

Efficacy and safety of erenumab for the preventive treatment of migraine have been established in 3 randomized, double-blind, placebo-controlled, multicenter studies in adults with a history of migraine, with or without aura, according to the International Classification of Headache Disorders, Third Edition (ICHD-3) diagnostic criteria.1,2,3,4 Two studies included patients with episodic migraine (4-14 migraine days per month) and another study included patients with chronic migraine (at least 15 headache days per month with at least 8 migraine days per month).1,2,3,4 The median age of patients in these studies was 42-43 years; the majority of patients were female (83-85%) and white (89-94%).1,2,3,4 All of the studies excluded patients with medication overuse headache (study 3 excluded those with medication overuse headache caused by opiates only) and patients with recent (within 12 months) cardiovascular or cerebrovascular events (i.e., myocardial infarction, stroke, transient ischemic attacks, unstable angina, coronary artery bypass surgery or other revascularization procedures).1,2,3,4 In all 3 studies, patients received treatment with erenumab-aooe or placebo, and were permitted to use acute headache treatments including antimigraine agents (e.g., selective serotonin type 1 [5-HT₁] receptor agonists [triptans], ergot alkaloids) and nonsteroidal anti-inflammatory agents (NSAIAs) as needed during the study.1,2,3,4 Concomitant preventive antimigraine treatment was permitted in the episodic migraine studies (studies 1 and 2).1 The primary measure of efficacy in these studies was the change from baseline in mean monthly migraine days.1,2,3,4 Secondary end points included the proportion of patients achieving at least a 50% reduction in mean migraine days per month and the number of acute antimigraine agent-use days per month.1,2,3,4 In the episodic migraine studies (studies 1 and 2), a patient-reported outcome, the mean monthly Migraine Physical Function Impact Diary (MPFID) score, also was assessed.1,2,3 The MPFID records the impact of migraine on everyday activities and physical impairment using an electronic diary administered daily and is calculated as a monthly score averaged over 28 days; reductions from baseline in MPFID scores indicate improvement.1

In study 1 (STRIVE), 955 adults with a history of episodic migraine were randomized to receive erenumab-aooe 70 mg, erenumab-aooe 140 mg, or placebo subcutaneously every month for 6 months; primary and secondary efficacy end points were assessed at months 4 through 6.1,2 Erenumab-aooe treatment substantially reduced monthly migraine days compared with placebo; from a mean baseline of approximately 8 migraine days per month, treatment with erenumab-aooe 70 or 140 mg reduced monthly migraine days by 3.2 or 3.7 days, respectively, compared with a reduction of 1.8 days with placebo.1,2 A reduction of at least 50% in mean migraine days per month was achieved in a substantially greater proportion of patients receiving erenumab-aooe 70 or 140 mg (43.3 or 50%, respectively) compared with placebo (26.6%), and the mean number of acute migraine-specific medication treatment days per month was reduced by 1.1 or 1.6 days in patients receiving erenumab-aooe 70 or 140 mg, respectively, compared with 0.2 days in placebo recipients.1,2 In addition, mean monthly MPFID scores were substantially reduced in patients treated with erenumab-aooe 70 or 140 mg compared with placebo.1,2

In study 2 (ARISE), 577 adults with a history of episodic migraine were randomized to receive erenumab-aooe 70 mg or placebo subcutaneously every month for 3 months; primary and secondary end points were assessed at month 3 in this study.1,3 From a mean baseline of approximately 8 migraine days per month, treatment with erenumab-aooe 70 mg reduced monthly migraine days by 2.9 days compared with a reduction of 1.8 days with placebo.1,3 A reduction of at least 50% in mean migraine days per month was achieved in a substantially greater proportion of patients receiving erenumab-aooe 70 mg compared with placebo (39.7 and 29.5%, respectively), and the mean number of acute migraine-specific medication treatment days was reduced by 1.2 days in patients receiving erenumab-aooe 70 mg compared with 0.6 days in placebo recipients.1,3 The mean monthly MPFID scores for everyday activity and physical impairment in patients receiving erenumab-aooe 70 mg did not differ substantially from those receiving placebo in this study.1,3

In study 3, 667 adults with a history of chronic migraine were randomized to receive erenumab-aooe 70 mg, erenumab-aooe 140 mg, or placebo subcutaneously every month for 3 months; primary and secondary efficacy end points were assessed at month 3.1,4 From a mean baseline migraine frequency of approximately 18 migraine days per month, treatment with erenumab-aooe 70 or 140 mg reduced monthly migraine days by 6.6 days compared with a reduction of 4.2 days with placebo.1,4 A reduction of at least 50% in mean migraine days per month was achieved in a substantially greater proportion of patients receiving erenumab-aooe 70 or 140 mg (39.9 or 41.2%, respectively) compared with placebo (23.5%), and the mean number of acute migraine-specific medication treatment days was reduced by 3.5 or 4.1 days in patients receiving erenumab-aooe 70 or 140 mg, respectively, compared with 1.6 days in placebo recipients.1,4

Post hoc analysis of studies 1 and 3 using weekly migraine days as a measure of efficacy indicate that a reduction in migraine days may be observed as early as the first week of treatment in patients with episodic or chronic migraine.6 In a long-term, open-label extension of a phase 2 study in patients with episodic migraine, 80% of enrolled patients completed 1 year of treatment with erenumab-aooe 70 mg once monthly; reductions from baseline in monthly migraine days and acute antimigraine agent-use days were sustained over at least 1 year of treatment with erenumab-aooe.7 Additional studies to evaluate long-term efficacy and safety of erenumab-aooe are needed.2,4,12

Clinical Perspective

The American Headache Society (AHS) has published expert consensus statements on integrating new migraine treatments into clinical practice over the last years.12,21 22 AHS states that erenumab and other anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies offer a number of advantages over some oral migraine preventive therapies, including no need for dosage escalation, rapid onset of therapeutic activity (within days to weeks), demonstrated efficacy after failure of prior preventive treatments or in combination with oral preventive treatments, minimal risk of adverse drug interactions, and favorable overall tolerability profiles.12 In 2024, AHS stated that CGRP-targeting therapies should be considered as a first-line approach for migraine prevention along with previous first-line treatments, without a requirement for prior failure of other migraine preventive drug classes.22 AHS noted that the cumulative evidence for the efficacy, safety, and tolerability of CGRP-targeting therapies is significantly greater than that for any established migraine preventive therapy.22

Similar to other commercially available antimigraine agents, erenumab is unlikely to achieve complete migraine freedom, but substantial reductions in migraine frequency were observed in controlled clinical trials.1,2,3,4,5

General

Patient Monitoring

• Monitor patients for hypersensitivity reactions.1
• Monitor patients for severe constipation.1
• Monitor patients for new-onset or worsening hypertension.1

Administration

Erenumab-aooe is administered by subcutaneous injection once monthly.1 The drug is commercially available in single-dose prefilled auto-injectors (i.e., injection pens) and single-dose prefilled syringes.1,17 Both the auto-injectors and syringes are intended for patient self-administration .1

Prior to use, patients and/or caregivers should receive proper training on how to prepare and administer erenumab-aooe using the prefilled auto-injectors and syringes.1 Consult the manufacturer's labeling for detailed instructions regarding subcutaneous administration of the drug.1

Administer subcutaneous injections into the abdomen, thigh, or outer area of the upper arm; avoid injections within 2 inches of the navel.1 Use the upper arm as an injection site if someone other than the patient (e.g., caregiver, healthcare professional) is administering the injection.1 Avoid injection into areas where the skin is tender, bruised, erythematous, or indurated.1

Store prefilled auto-injectors and syringes of erenumab-aooe at 2-8°C in the original carton to protect the drug from light until time of use.1 The auto-injectors and syringes may be stored at room temperature up to 25°C in the original carton for up to 7 days.1 Discard the drug if it is stored for more than 7 days at room temperature.1 Do not freeze or shake the prefilled auto-injectors and syringes.1

Prior to subcutaneous administration, remove the prefilled auto-injectors and syringes from their carton and allow them to sit at room temperature for at least 30 minutes; avoid exposure to direct sunlight.1 The auto-injectors and syringes should not be warmed by using a heat source (e.g., microwave, hot water).1 Prior to administration, visually inspect the solution for particulate matter and discoloration; do not use the drug if it is cloudy or discolored or contains flakes or particles.1 The prefilled auto-injectors and syringes are intended for single-use only; discard any unused portions.1

Dosage

Preventive Treatment of Migraine

For the preventive treatment of migraine in adults, the recommended dosage of erenumab-aooe is 70 mg once monthly by subcutaneous injection.1 A higher dosage of 140 mg once monthly by subcutaneous injection may be considered in some patients.1 There does not appear to be a need for dosage titration with erenumab; therapy may be initiated with either the 70- or 140-mg dose.12 The American Headache Society (AHS) recommends assessing the clinical efficacy of erenumab after 3 months of treatment and continuing therapy only if treatment benefits have been observed with the drug by that time.21

If a dose of erenumab-aooe is missed, administer the missed dose as soon as possible.1 Subsequent doses may then be scheduled monthly from the date of the last administered dose.1

The risk of adverse drug interactions with erenumab appears to be minimal.1,12 When initiating therapy with erenumab or another anti-calcitonin gene-related peptide (CGRP) monoclonal antibody in a patient who is already receiving a preventive treatment for migraine, AHS recommends adding the anti-CGRP monoclonal antibody to the existing antimigraine regimen.12 The decision to discontinue the established preventative therapy should take into account the onset and magnitude of treatment effect with the anti-CGRP monoclonal antibody.21

Special Populations

Hepatic Impairment

The manufacturer makes no specific dosage recommendations for patients with hepatic impairment.1

Renal Impairment

The manufacturer makes no specific dosage recommendations for patients with renal impairment.1

Geriatric Patients

Select dosage carefully in geriatric patients, usually starting at the low end of the dosage range.1

Contraindications

• Serious hypersensitivity to erenumab-aooe or any excipients in the formulation.1

Warnings/Precautions

Hypersensitivity Reactions

Hypersensitivity reactions, including rash, angioedema, and anaphylaxis, have been reported in patients receiving erenumab during postmarketing experience.1 Most of the hypersensitivity reactions reported to date were not serious and occurred within hours of administration; however, some reactions occurred more than one week following administration.1

If a serious or severe hypersensitivity reaction occurs, discontinue administration of erenumab and initiate appropriate therapy.1

Constipation with Serious Complications

Constipation with serious complications, in some cases requiring hospitalization or surgery, has been reported during postmarketing experience with erenumab.1 In a majority of these cases, the onset of constipation was reported after the first dose of the drug; however, constipation also has presented later during treatment.1 Erenumab therapy was discontinued in most reported cases of constipation with serious complications.1

Monitor patients for severe constipation and manage as clinically appropriate.1 Concomitant use of drugs associated with decreased GI motility may increase the risk for more severe constipation and the potential for constipation-related complications.1

Hypertension

New-onset hypertension and worsening of preexisting hypertension, in some cases requiring treatment or hospitalization, have been reported during postmarketing experience with erenumab.1 Many of the patients had preexisting hypertension or risk factors for hypertension.1 Hypertension may occur at any time during treatment with erenumab but was most frequently reported within 7 days of dose administration; in the majority of cases, the onset or worsening of hypertension was reported after the first dose.1 Erenumab therapy was discontinued in many of the reported cases.1

Monitor patients for new-onset or worsening hypertension.1 If hypertension occurs, consider discontinuance of erenumab if an alternative etiology cannot be identified.1

Immunogenicity

As with all therapeutic proteins, there is a potential for immunogenicity with erenumab therapy.1 In controlled clinical studies, anti-erenumab antibodies were detected in 6.2 or 2.6% of patients who received subcutaneous injections of the drug at dosages of 70 or 140 mg once monthly, respectively.1 In a long-term study, anti-erenumab antibodies were detected in 11.1% of patients who received the 70 or 140 mg dosages.1 Although available data do not demonstrate an effect of anti-erenumab antibody development on the efficacy or safety of erenumab, the data are too limited to make definitive conclusions.1

Specific Populations

Pregnancy

There are no adequate data to date on the developmental risk associated with the use of erenumab in pregnant women.1 Animal studies in pregnant monkeys administered erenumab-aooe subcutaneously at dosages resulting in systemic exposures approximately 20 times the exposure from the maximum recommended human dosage (140 mg monthly) throughout gestation have not revealed evidence of harm to the offspring.1

The estimated rates of major birth defects and miscarriage among deliveries to women with migraine (2.2-2.9 and 17%, respectively) are similar to rates reported in women without migraine.1 Clinicians should be aware that published data suggest that women with migraine may be at increased risk of preeclampsia and gestational hypertension during pregnancy.1

A pregnancy registry that monitors outcomes in women exposed to erenumab during pregnancy has been established.1 Patients may be enrolled by calling 833-244-4083 or visiting [Web].1

Lactation

It is not known whether erenumab is distributed into human milk.1 The effects of the drug on the breast-fed infant or on milk production also are unknown.1 Consider the developmental and health benefits of breast-feeding along with the mother's clinical need for erenumab and any potential adverse effects on the breast-fed infant from the drug or from the underlying maternal condition.1

Pediatric Use

The manufacturer states that the safety and efficacy of erenumab-aooe have not been established in pediatric patients <18 years of age.1

Pending further clinical experience with the use of anti-CGRP monoclonal antibodies in pediatric patients, the Pediatric and Adolescent Headache special interest group of the American Headache Society (AHS) recommends that anti-CGRP monoclonal antibodies (e.g., erenumab, fremanezumab, galcanezumab) should be considered mainly for use in postpubertal adolescents† with relatively frequent migraines (i.e., 8 or more headache days per month) who have moderate to severe disability associated with migraine (e.g., PedMIDAS score of 30 or more) and in whom at least 2 preventive therapies (including pharmacologic and non-pharmacologic therapies and dietary supplements) have failed.11 For younger pediatric patients† with severe chronic migraine that is refractory to multiple preventive therapies, these experts recommend that anti-CGRP monoclonal antibodies be considered only in carefully selected patients with close monitoring (e.g., pubertal status, bone health, linear growth, weight, body mass index [BMI], infectious complications).11

Geriatric Use

Clinical trials of erenumab did not include sufficient numbers of patients ≥65 years of age to determine whether they respond differently than younger adults.1 The manufacturer recommends cautious dosage selection in geriatric patients, usually starting at the low end of the dosage range, taking into consideration the greater frequency of decreased hepatic, renal, and/or cardiac function and other concomitant disease and drug therapy in this population.1

Hepatic Impairment

Formal pharmacokinetic studies of erenumab have not been conducted in patients with hepatic impairment.1 Hepatic impairment is not expected to affect pharmacokinetics of the drug.1

Renal Impairment

Renal impairment is not expected to affect the pharmacokinetics of erenumab.1 Formal pharmacokinetic studies of the drug have not been conducted in patients with renal impairment.1 Analysis of population pharmacokinetic data indicates that the pharmacokinetics of erenumab are not influenced by mild or moderate renal impairment.1 Erenumab has not been evaluated in patients with severe renal impairment (estimated glomerular filtration rate [eGFR] <30 mL/minute per 1.73 m²).1

Common Adverse Effects

Adverse effects reported in ≥3% of patients receiving erenumab-aooe for migraine in placebo-controlled clinical studies and more frequently than with placebo include injection site reactions (e.g., pain, erythema, pruritus) and constipation.1,5,17

The risk of clinically important drug interactions with erenumab appears to be minimal.1,5,12 Erenumab is not metabolized by cytochrome P-450 (CYP) isoenzymes.1 In addition, erenumab is unlikely to have an effect on drug-metabolizing enzymes or drug transporters.5 Therefore, pharmacokinetic interactions with drugs affecting or metabolized by CYP enzymes or substrates of various drug transport systems are not expected.1,5,12

Drugs Associated with Decreased GI Motility

Concomitant use of erenumab and drugs associated with decreased GI motility may increase the risk of severe constipation and constipation-related complications.1

Oral Contraceptives

Concomitant administration of erenumab-aooe (single 140-mg subcutaneous dose) and an oral contraceptive containing ethinyl estradiol and norgestimate in healthy females did not affect the pharmacokinetics of the oral contraceptive.1

Sumatriptan

In a double-blind, placebo-controlled study, concomitant administration of erenumab-aooe (single 140-mg IV† dose) and sumatriptan (two 6-mg subcutaneous doses given 1 hour apart) in healthy individuals did not affect the pharmacokinetics of sumatriptan.1,5,19 Concomitant administration of erenumab-aooe and sumatriptan also did not increase mean arterial pressure and resting blood pressure any more than sumatriptan administered alone.1,5,19 In addition, administration of erenumab-aooe alone does not appear to affect resting blood pressure.19 Concomitant administration of erenumab-aooe and sumatriptan generally appears to be well tolerated.19

Description

Erenumab is a fully human immunoglobulin G₂ (IgG₂) monoclonal antibody that binds to the calcitonin gene-related peptide (CGRP) receptor and antagonizes CGRP receptor function.1,8,9 The drug is produced using recombinant DNA technology in Chinese hamster ovary cells.1

CGRP is a potent vasodilator and pain-signaling neuropeptide that has been associated with migraine pathophysiology.8,9,10,17,18 CGRP and its receptors are located at sites that are relevant to migraine development such as the trigeminal neurons and are also widely distributed throughout the CNS and peripheral nervous system as well as in non-neuronal tissues throughout the body.8,9,10,11,17,18

Increased serum CGRP concentrations have been observed in individuals during acute migraine attacks (with or without aura) and IV infusion of CGRP has been shown to induce migraines in patients with a history of migraines.8,9,10,17,18 Erenumab potently and selectively binds to the extracellular binding site of the CGRP receptor thereby competitively blocking its interaction with CGRP.5,8,9,10,17 Because of its large molecular size, erenumab is unlikely to cross the blood-brain barrier and probably antagonizes CGRP receptor function peripherally rather than centrally within the nervous system.11,13,18

Erenumab exhibits nonlinear pharmacokinetics due to binding to the CGRP receptor.1,17 However, at clinically relevant dosages (70-140 mg by subcutaneous injection once monthly), pharmacokinetics of the drug are predominantly linear because of saturation of binding to the CGRP receptor.1,5,17 Following a single subcutaneous dose of 70 or 140 mg in healthy adults, peak serum erenumab concentrations are attained in approximately 6 days.1 Following once-monthly subcutaneous administration of erenumab-aooe in migraine patients, steady-state trough serum concentrations of the drug are approached in 3 months; systemic accumulation of the drug is less than twofold.1 The estimated absolute bioavailability following a single subcutaneous dose of 70 or 140 mg is 82%.1 Antimigraine effects of erenumab usually are evident following 1-3 monthly subcutaneous injections of the drug in responding patients.12 At low concentrations, erenumab is predominantly eliminated through saturable binding to the CGRP receptor while at higher concentrations, elimination of the drug is principally through a nonspecific, nonsaturable proteolytic pathway.1 The effective half-life of erenumab-aooe is 28 days.1

The pharmacokinetics of erenumab-aooe are not affected by age, sex, race, or subtypes of migraine spectrum (e.g., episodic or chronic migraine).1

Advice to Patients

• Advise patients to read the manufacturer's patient information and instructions for use.1
• Provide guidance to patients and/or caregivers on proper subcutaneous administration of erenumab-aooe, including the use of aseptic technique, and use of the single-dose auto-injectors or syringes.1 Instruct patients and/or caregivers to read and follow the instructions for use each time they use erenumab-aooe.1
• If a dose is missed, administer the missed dose as soon as possible.1 Schedule subsequent doses monthly from the date of the last administered dose.1
• Advise patients to seek immediate medical attention if they experience any symptoms of serious or severe hypersensitivity reactions.1
• Risk of constipation with serious complications, including the need for hospitalization or surgery.1 Advise patients to contact their clinician if they experience severe constipation.1
• Risk of developing hypertension or worsening of pre-existing hypertension.1 Advise patients to contact their clinician if they experience elevation in their blood pressure.1
• Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as any concomitant illnesses (e.g., hypertension).1
• Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1 Advise patients that there is a pregnancy exposure registry that monitors outcomes in women exposed to erenumab during pregnancy.1
• Inform patients of other important precautionary information.1

Additional Information

The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer's labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.

1. Amgen Inc. Aimovig^® (erenumab-aooe) injection, for subcutaneous use prescribing information. Thousand Oaks, CA; 2023 May.

2. Goadsby PJ, Reuter U, Hallström Y et al. A controlled trial of erenumab for episodic migraine. N Engl J Med . 2017; 377:2123-2132. [PubMed 29171821]

3. Dodick DW, Ashina M, Brandes JL et al. ARISE: A Phase 3 randomized trial of erenumab for episodic migraine. Cephalalgia . 2018; 38:1026-1037. [PubMed 29471679]

4. Tepper S, Ashina M, Reuter U et al. Safety and efficacy of erenumab for preventive treatment of chronic migraine: a randomised, double-blind, placebo-controlled phase 2 trial. Lancet Neurol . 2017; 16:425-434. [PubMed 28460892]

5. US Food and Drug Administration. Center for Drug Evaluation and Research. Application number 761077Orig1s000: Summary review. From FDA website. [Web]

6. Schwedt T, Reuter U, Tepper S et al. Early onset of efficacy with erenumab in patients with episodic and chronic migraine. J Headache Pain . 2018; 19:92. [PubMed 30276500]

7. Ashina M, Dodick D, Goadsby PJ et al. Erenumab (AMG 334) in episodic migraine: Interim analysis of an ongoing open-label study. Neurology . 2017; 89:1237-1243. [PubMed 28835404]

8. Shi L, Lehto SG, Zhu DX et al. Pharmacologic characterization of AMG 334, a potent and selective human monoclonal antibody against the calcitonin gene-related peptide receptor. J Pharmacol Exp Ther . 2016; 356:223-31. [PubMed 26559125]

9. Edvinsson L, Haanes KA, Warfvinge K et al. CGRP as the target of new migraine therapies - successful translation from bench to clinic. Nat Rev Neurol . 2018; 14:338-350. [PubMed 29691490]

10. Schuster NM, Rapoport AM. Calcitonin gene-related peptide-targeted therapies for migraine and cluster headache: a review. Clin Neuropharmacol . 2017 Jul/Aug; 40:169-174. [PubMed 28644160]

11. Szperka CL, VanderPluym J, Orr SL et al. Recommendations on the use of anti-CGRP monoclonal antibodies in children and adolescents. Headache . 2018; 58:1658-69. [PubMed 30324723]

12. American Headache Society. The American Headache Society position statement on integrating new migraine treatments into clinical practice. Headache . 2019; 59:1-18. [PubMed 30536394]

13. Raffaelli B, Reuter U. The biology of monoclonal antibodies: focus on calcitonin gene-related peptide for prophylactic migraine therapy. Neurotherapeutics . 2018; 15:324-35. [PubMed 29616494]

17. Novartis Europharm Limited. Aimovig^® (erenumab) injection, solution for injection summary of product characteristics. Dublin, Ireland; 2018 Aug 8.

18. Edvinsson L. The trigeminovascular pathway: role of CGRP and CGRP receptors in migraine. Headache . 2017; 57:47-55. [PubMed 28485848]

19. de Hoon J, Van Hecken A, Vandermeulen C et al. Phase 1, randomized, parallel-group, double-blind, placebo-controlled trial to evaluate the effects of erenumab (AMG 334) and concomitant sumatriptan on blood pressure in healthy volunteers. Cephalalgia . 2019; 39:100-110. [PubMed PMID: 29783863]

21. Ailani J, Burch RC, Robbins MS et al. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache . 2021; 61:1021-1039. [PubMed 34160823]

22. Charles AC, Digre KB, Goadsby PJ, et al. Calcitonin gene-related peptide-targeting therapies are a first-line option for the prevention of migraine: an American Headache Society position statement update. Headache. 2024;1-9. [Web]