What is Aimovig?
Aimovig (erenumab-aooe) is a once-monthly subcutaneous injection that blocks the calcitonin gene-related peptide (CGRP) receptor to prevent migraine attacks in adults. 1
Mechanism and Drug Class
Aimovig is a fully human monoclonal antibody and the first FDA-approved antibody targeting a G-protein-coupled receptor. 1, 2 It works by antagonizing the CGRP receptor, which prevents the vasodilation and pain signaling that occurs during migraine attacks. 3, 4 This represents a fundamentally different mechanism than traditional migraine preventive medications like beta-blockers or antidepressants.
Clinical Use and Positioning
According to the 2025 American College of Physicians guidelines, Aimovig should be reserved as second-line therapy for episodic migraine prevention in nonpregnant adults who have failed or cannot tolerate first-line agents (beta-blockers like metoprolol/propranolol, valproate, venlafaxine, or amitriptyline). 5
The guideline explicitly recommends using CGRP monoclonal antibodies (including erenumab/Aimovig, along with eptinezumab, fremanezumab, or galcanezumab) only after inadequate response or intolerance to first-line medications. 5 This positioning reflects both the higher cost of CGRP antibodies compared to generic alternatives and the conditional strength of evidence (low-certainty) showing no clear superiority in net benefit over traditional agents. 5
Dosing and Administration
- Standard dose: 70 mg subcutaneously once monthly 1
- Alternative dose: 140 mg once monthly for patients who may benefit from higher dosing 1
- Route: Subcutaneous injection in abdomen, thigh, or upper arm 1
- Preparation: Allow to reach room temperature for at least 30 minutes before injection 1
Available as prefilled autoinjector or prefilled syringe. 1
Efficacy
Meta-analyses demonstrate that erenumab reduces:
- Monthly migraine days by 1.0-2.5 days compared to placebo 6
- Acute medication use by approximately 1.36-1.72 days per month 7, 8
- Headache Impact Test (HIT-6) scores by 2.83 points 8
Approximately 50% more patients achieve ≥50% reduction in monthly migraine days compared to placebo. 8 Notably, erenumab appears more effective in patients with prior preventive treatment failures. 8
The medication is effective for both episodic and chronic migraine, including patients with medication overuse headache. 7, 6
Safety Profile
Aimovig has a favorable adverse event profile with tolerability similar to placebo. 4, 8 The most common adverse reactions (≥3% and more than placebo) are:
Important Warnings
Hypersensitivity reactions: Can occur within hours to more than one week after administration; discontinue if serious reaction occurs 1
Constipation with serious complications: Severe cases requiring hospitalization or surgery have been reported; patients should contact providers for severe constipation, persistent abdominal pain, vomiting, or bloating 1
Hypertension: New-onset or worsening of pre-existing hypertension may occur 1
Contraindications
Serious hypersensitivity to erenumab-aooe or any excipients 1
Special Populations
- Pregnancy: Unknown risk; pregnancy registry available (1-833-244-4083) 1
- Breastfeeding: Unknown if excreted in breast milk 1
- Pediatrics: Not approved for patients under 18 years 1
Storage
Refrigerate at 2°C to 8°C (36°F to 46°F). If removed from refrigerator, may be kept at room temperature (up to 25°C/77°F) for up to 7 days; discard after 7 days at room temperature. Do not freeze or shake. 1
Cost Considerations
The ACP guideline emphasizes that economic factors were primary drivers in recommending CGRP antibodies as second-line therapy, given their substantially higher wholesale acquisition costs compared to generic first-line agents, despite similar efficacy profiles. 5 Real-world adherence data shows approximately 80% adherence rates. 9