When do patients with a history of migraines or cluster headaches typically notice benefits after starting treatment with Emgality (galcanezumab)?

When Patients Notice Benefits on Emgality (Galcanezumab)

Patients typically notice benefits from Emgality within the first few weeks of treatment, with effects becoming apparent as early as the first week after initiation. 1

Timeline for Therapeutic Response

Migraine Prevention

• Improvement occurs gradually after initiation, with effects that may become apparent after the first few weeks of treatment. 1
• Adherence to pharmacologic treatment is crucial because the full preventive effect develops over time rather than immediately. 1
• Treatment response should be formally evaluated after 2-3 months to determine if an adequate response has been achieved. 1
• If an adequate response is not achieved during this reasonable trial period of 2-3 months, consider switching to an alternative preventive medication. 1

Cluster Headache Treatment

• For episodic cluster headache, galcanezumab 300 mg demonstrated a mean reduction in weekly attack frequency within weeks 1-3 after the initial injection, with 71% of patients achieving at least 50% reduction in headache frequency by week 3. 2
• In clinical practice case series, patients with episodic cluster headache saw their cluster bout end a mean of 17.3 days (range 10-28 days) after galcanezumab administration. 3
• For chronic cluster headache, patients with refractory disease showed >50% frequency reduction in 83% of cases by month 3 of treatment. 3

Monitoring Treatment Effectiveness

Assessment Tools

• Use headache diaries to capture attack frequency, severity, and migraine-related disability—these require minimal time commitment if completed only on symptomatic days. 1
• The Migraine Treatment Optimization Questionnaire (mTOQ-4) can assess effectiveness at follow-up visits. 1
• The HURT questionnaire (Headache Under-Response to Treatment) generates specific suggestions for management changes when outcomes are suboptimal. 1

Key Metrics to Track

• Migraine frequency (number of migraine days per month) 1
• Attack severity and duration 1
• Migraine-related disability and quality of life 1
• Acute medication consumption days 1

Important Clinical Considerations

Setting Realistic Expectations

• Counsel patients that preventive medications work gradually, not immediately, to improve adherence during the initial weeks when full benefit may not yet be apparent. 1
• The gradual onset of benefit differs from acute medications, which work within hours. 1
• Some patients may experience benefit earlier than others, but the standard evaluation period remains 2-3 months. 1

When to Reassess

• Evaluate treatment response shortly after initiation (after 2-3 months) or following any treatment change. 1
• Continue regular evaluations every 6-12 months thereafter. 1
• If outcomes remain suboptimal after 2-3 months, review the diagnosis, treatment strategy, dosing, and adherence before concluding treatment failure. 1

Safety Profile

• In long-term studies with up to 15 months of galcanezumab treatment, the most common adverse events were nasopharyngitis (17.6%) and injection site pain (14.2%). 4
• Injection site reactions occurred in 27.5% of patients, including hypersensitivity events in 6% of cases. 4
• The medication demonstrated a favorable tolerability profile with only 7.7% discontinuing due to adverse events. 4