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Failed Aimovig/Botox, time for a new CGRP or ???

Aimovig and Botox didn’t help my dizziness (VM) & my neurologist (not a dizziness Neurologist expert but they seem to say the same) thinks we should just try one of the new CGRP migraine drugs (I’m leaning to Emgality over Ajovy given posts on here). I’ve tried multiple drugs in all the main preventative classes/triptans/yada. The main thing really left to try that I know of is multiple preventatives at the same time but I think I kind of did that as I was on lamictal while I was trying all those different migraine drugs.

I spoke to a top neuropsychologist who said she didn’t think she could help and my past vestibular therapist (and the head of his department), cranio-sacral therapist, and PT (saw several) said they helped as much as they could. Unsure what else to do but I guess it is just an endless trial of drugs and stay positive and maybe this goes away (it’s been since 2011 constant dizziness)

I think you like me and @GetBetter and @ander454 and a bunch of others are down to this last new class of meds - the CGRP receptor antagonists. It’s that or keep trying cocktails.

Sorry aren’t CGRP receptor antagonists only acute at this point? My dizziness is daily so if I’m not mistaken my neuro would probably say try Emgality and/or Ajovy. It also seems like CGRP receptor antagonists have pretty serious liver effects.

My concern with Emgality and Ajovy is they also may have longterm negative effects, and part of me just wants to go screw it I’ll just live with this condition, but right now my insurance covers my meds/doctors’ visits so why not try what’s out there I guess

I think the fear for long term side effects is potentially cardiovascular. I didn’t see anything about liver.

https://thejournalofheadacheandpain.biomedcentral.com/track/pdf/10.1186/s10194-017-0807-1

Yes anti-cgrp is not metabolized by the liver. So 0 interaction with other drugs. Does not cross blood brain barrier also so wont mess up brain chemistry ie depression anxiety.

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Sorry I think I meant a different organ. Either way sadly my understanding is that CGRP receptor antagonists are only acute currently so unless I’m mistaken, I shouldn’t try them given I’m dizzy 24/7 (though I do have upticks in dizziness depending on stress or some other external stimulus or so).

Would ya’ll recommend trying a CGRP receptor antagonists like Nurtec ODT or Ubrelvy, or instead try Emgality or Ajovy?

Aimovig (Ubrevly) is a CGRP medication so you have already tried a CGRP, right? but yeah I’d keep trying new things / combos if I were you. I’m having good success with Amitriptyline, Emgality, and Cefaly. Three prong attack! Of course I manage stress and eat mostly a migraine diet too among other things.

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