Aimovig (Erenumab) for Migraine Prevention
Recommended Dosage
The FDA-approved dosage of Aimovig is 70 mg subcutaneously once monthly, with some patients benefiting from 140 mg once monthly. 1
Administration Details
- Route: Subcutaneous injection only in the abdomen, thigh, or upper arm 1
- Frequency: Once monthly; if a dose is missed, administer as soon as possible and resume monthly schedule from that date 1
- Preparation: Allow Aimovig to sit at room temperature for at least 30 minutes before injection (do not use heat sources or shake the product) 1
- Inspection: Do not use if solution is cloudy, discolored, or contains flakes or particles 1
Dosing Considerations by Patient Population
- In clinical trials, patients with 2-4 prior failed preventive treatments showed significant efficacy with both 70 mg and 140 mg doses 2
- Real-world Canadian data showed 93.7% of patients initiated treatment with 140 mg dosing 3
- For episodic migraine, 140 mg erenumab reduced monthly migraine days by 3.7 days versus 1.8 days with placebo 4
Potential Side Effects
Most Common Adverse Effects (≥3% and more than placebo)
- Injection site reactions (6%): Including pain, erythema, and pruritus 1
- Constipation (1-3%): One of the most frequently reported adverse events 1
Serious Complications Requiring Monitoring
Constipation with serious complications can occur and may require hospitalization or surgery; onset typically occurs after the first dose but can present later in treatment 1. Monitor all patients for severe constipation and avoid concurrent use of medications that decrease gastrointestinal motility 1.
Hypertension (new-onset or worsening) has been reported, most frequently within 7 days of administration and often after the first dose 1. Monitor blood pressure, particularly in patients with pre-existing hypertension or cardiovascular risk factors 1.
Hypersensitivity reactions including rash, angioedema, and anaphylaxis can occur within hours to more than one week after administration 1. If serious hypersensitivity occurs, discontinue Aimovig immediately and initiate appropriate therapy 1.
Additional Postmarketing Adverse Events
Real-World Safety Data
- In a tertiary headache clinic study, 42.9% of discontinuations were due to adverse effects, with constipation being notably high 5
- A "wearing-off" response at 1 week before the next dose was observed in real-world practice 5
- Overall discontinuation rate was 27.7% in complex tertiary care patients, with 39.3% discontinuing due to lack of efficacy 5
Contraindications
Aimovig is absolutely contraindicated in patients with serious hypersensitivity to erenumab-aooe or any excipients, including those with prior anaphylaxis or angioedema. 1
Clinical Efficacy Expectations
Response Timeline
- Evaluate treatment response at 2-3 months after initiation using headache calendars to track attack frequency, severity, and migraine-related disability 6
- In real-world Canadian practice, 33.7% of patients achieved ≥50% reduction in monthly migraine days at week 12, with 34.9% achieving this at week 24 3
Efficacy in Treatment-Refractory Patients
- For patients with ≥2 prior failed preventive medication categories, erenumab 140 mg reduced monthly migraine days by 4.3 days versus placebo 7
- In patients with 2-4 prior treatment failures, 30% achieved ≥50% reduction in monthly migraine days with 140 mg dosing 2
Critical Clinical Pitfalls
Do not use Aimovig as first-line preventive therapy—it is classified as a third-line medication by the American Academy of Neurology, reserved for patients who have failed conventional oral preventives 6.
Avoid in patients with history of stroke due to potential increased risk of adverse cardiovascular events 6.
Avoid in patients with impaired wound healing due to potential increased risk of adverse events 6.