Galcanezumab for the prevention of migraine

18th January 2021 by Dr Louise Hudman

Galcanezumab for the prevention of migraine

This new guideline was published in November 2020 and is about galcanezumab for the prevention of migraine from NICE advising that galcanezumab can be used in the prevention of certain kinds of migraine.

What is galcanezumab?

  • It is a recombinant monoclonal antibody.
  • It is injected subcutaneously monthly (this would normally be self-injection).
  • It binds to CGRP (calcitonin gene-related peptide) and stops it binding to its receptor. CGRP is thought to play a role in migraines.

When can it be used?

It can be used in adults IF:

  • they have four or more migraine days a month AND
  • at least three other preventative drugs have failed.

It must be stopped after 12 weeks IF:

  • in episodic migraine, the headache frequency doesn’t reduce by at least 50% OR
  • in chronic migraine, the headache frequency doesn’t reduce by a least 30%.

How do we define episodic and chronic migraine?

  • Episodic migraine – Fewer than 15 headache days a month.
  • Chronic migraine – 15 or more headache days a month, with at least eight of these having migraine features.

Who should be prescribing this?

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