Does Aimovig Require a Loading Dose?
No, Aimovig (erenumab) does not require a loading dose for initiation of therapy. The FDA-approved dosing is 70 mg or 140 mg administered once monthly via subcutaneous injection, with no loading dose specified 1.
Standard Initiation Protocol
Start with 70 mg once monthly as the recommended initial dose, administered subcutaneously in the abdomen, thigh, or upper arm 1.
Some patients may benefit from 140 mg once monthly, particularly those with difficult-to-treat migraine or prior treatment failures 2, 3.
No dose escalation period is required—patients begin at their target maintenance dose from the first injection 1.
Rationale for No Loading Dose
The pharmacokinetic profile of erenumab does not necessitate loading:
Erenumab is a fully human monoclonal antibody targeting the CGRP receptor, with predictable absorption and distribution kinetics that allow for immediate therapeutic effect at standard monthly dosing 4, 5.
Clinical trials demonstrated efficacy using monthly dosing without loading, with significant reductions in monthly migraine days observed by months 4-6 of treatment 5.
The 140 mg dose provides numerically better efficacy across migraine outcomes compared to 70 mg, but this is achieved through higher monthly dosing rather than front-loading 2.
When to Consider Starting at 140 mg
Initiate with 140 mg monthly in patients with:
High treatment failure burden—those who have failed 2-4 prior preventive treatments 3.
Difficult-to-treat migraine—patients with high baseline migraine frequency (8-14 migraine days per month) 2, 3.
Need for maximal efficacy—when rapid and robust response is clinically important, as 140 mg shows superior reduction in monthly migraine days 2.
Common Pitfall to Avoid
Do not confuse the absence of a loading dose with delayed efficacy. While some preventive migraine treatments require weeks to months for full effect, erenumab demonstrates measurable benefit within the first month, with continued improvement through month 3-6 of treatment 5. The lack of loading dose does not indicate slower onset compared to other preventive therapies.