Emgality

Emgality is a preventive treatment used in adults for migraine prevention. It is suitable for patients who experience at least 4 migraine days per month. It is not used to treat an active migraine attack.

Emgality is a CGRP monoclonal antibody. It works by blocking calcitonin gene-related peptide (CGRP), a molecule involved in migraine pain pathways. By reducing CGRP activity, it helps reduce the frequency of migraine attacks over time.

• Given as a self-injection once monthly
• Administered using a pre-filled pen or syringe
• It is a preventive treatment, not a pain relief medication

Episodic migraine (EVOLVE-1 & EVOLVE-2 trials)

Patients had fewer monthly migraine headache days compared with placebo:

• EVOLVE-1: 4.7 vs 2.8 fewer migraine days/month
• EVOLVE-2: 4.3 vs 2.3 fewer migraine days/month
• Results measured over 6 months

Chronic migraine (REGAIN trial)

• 4.8 vs 2.7 fewer migraine days/month (Emgality vs placebo)
• Measured over 3 months

Responder rates (≥50% reduction in migraine days)

• Up to ~73–80% of patients achieved ≥50% reduction in migraine-related disability in clinical trials
• Compared with ~55% on placebo

Key clinical trial summary (safety & tolerability)

Across clinical studies:

• Most common adverse effect: injection site reactions (≥2%)
• Discontinuation due to side effects: low
• Overall tolerability: generally favourable compared with placebo

Emgality may be considered for adults with:

• 4 or more migraine days per month
• Inadequate response, intolerance, or contraindication to other preventive treatments
• Chronic or episodic migraine requiring preventive therapy

Common side effects

The most common side effects are:

• Injection site reactions (pain, redness, swelling)

Emgality may not be suitable if you have:

• Severe allergy to galcanezumab or ingredients in the injection
• Significant uncontrolled cardiovascular or vascular disease (requires clinical review)
• History of significant hypersensitivity reactions to monoclonal antibody therapies

Special precautions

Patients should inform their clinician if they have:

• High blood pressure
• Circulation disorders (e.g. Raynaud’s)
• Pregnancy or breastfeeding
• Other ongoing medical conditions or medications

Emgality may not be suitable if you have:

• Severe allergy to galcanezumab or ingredients in the injection
• Significant uncontrolled cardiovascular or vascular disease (requires clinical review)
• History of significant hypersensitivity reactions to monoclonal antibody therapies

Special precautions

Patients should inform their clinician if they have:

• High blood pressure
• Circulation disorders (e.g. Raynaud’s)
• Pregnancy or breastfeeding
• Other ongoing medical conditions or medications

How quickly does it work?

• Some patients notice improvement within 1–4 weeks
• Full response is usually assessed after 2–3 months

Do I need to try other treatments first?

In most pathways:

• At least 2–3 preventive treatments are usually tried first
• Exceptions apply if treatments are not suitable or not tolerated due to medical reasons

Other migraine preventive options may still be available, including:

• Alternative CGRP inhibitors
• Oral preventive medications
• Specialist headache clinic pathways

High blood pressure

• New or worsening high blood pressure has been reported
• Blood pressure should be monitored during treatment
• Seek medical advice if BP increases

Raynaud’s phenomenon

May develop or worsen during treatment

Symptoms include:

• Cold, numb, or painful fingers/toes
• Colour changes (white/blue/red)

Treatment should be reviewed if symptoms occur

Allergic (hypersensitivity) reactions

• Rash, swelling (angioedema), urticaria, or breathing difficulty may occur
• Rare cases of anaphylaxis reported
• Reactions may occur days after injection
• Stop treatment and seek urgent medical care if severe reaction occurs

Other reported risks

• Fatigue
• Mild systemic symptoms are uncommon