Galcanezumab (Emgality) injections for migraine

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Why have I been given this information?

You have been given this information because you are being treated for migraines. A medicine called Emgality is one of the treatment options.

What is Emgality and how does it work?

Emgality is a prescription medicine used to prevent migraines in adults who have at least four migraine days a month.

Emgality is a CGRP medicine. Emgality works by blocking the protein called Calcitonin Gene-Related Peptide. This protein is related to pain transmission in your brain. This means that migraines will happen less often, and when they do happen, they will be less severe.

How is Emgality administered?

Emgality is an injection that you can give yourself on the same date every calendar month. You can inject it into your thigh or abdomen (stomach). The injections come in a pre-filled pen, so you do not have to prepare them yourself.

The very first dose is double (two injections), with one injection per month after this.

Who can take Emgality?

You will be given Emgality if:  

• you have four or more migraines a month and

• you have tried at least three other preventative drugs and they have not helped to improve your migraines, or you could not tolerate the side effects to those drugs.

Does Emgality have any side effects?

Like all medicines, Emgality can cause side effects, although not everybody gets them.  

Allergic reactions with Emgality are usually mild to moderate (such as rash or itching). Serious allergic reactions may occur rarely (may affect up to 1 in 1 000 people) and the signs may include:

• difficulty breathing or swallowing,  
• low blood pressure, which can cause dizziness or light-headedness,  
• swelling of the neck, face, mouth, lips, tongue or throat which may develop rapidly  
• severe itching of the skin, with a red rash or raised bumps.  

Very common side effects (may affect more than 1 in 10 people):

• Injection site pain  
• Injection site reactions (for example, red skin, itching, bruising, swelling)

Common side effects (may affect up to 1 in 10 people):

• Vertigo (a feeling of dizziness or “spinning”)  
• Constipation  
• Itching  
• Rash

Uncommon side effects (may affect up to 1 in 100 people):

• Hives (raised itchy areas of skin) 

What should I do if I experience these?

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet.  

You can also report side effects directly via the Yellow Card Scheme.

Which health conditions that I may have had must I tell my consultant or the headache nursing team about?

You must not take Emgality if you are pregnant or breastfeeding.

Some health conditions mean that taking Emgality might not be safe for you. Let your consultant or headache nursing team know if you have ever experienced or experience any of the following:

• high blood pressure (blood pressure over 150mmHg systolic)
• heart attack
• stroke
• DVT
• transient ischemic attack (TIA)
• unstable angina
• if you plan pregnancy in the near future or if you are breastfeeding
• a disease or condition which has damaged your liver or kidneys, so they do not work as well
• have bowel disease that makes you more likely to be constipated.

What happens after I start using Emgality?

When you start using Emgality, you will be offered a three month trial:

• Month 1: two injections at the same time 
• Month 2: one injection 
• Month 3: one injection

One week after injection on month three you will have a telephone follow-up with one of our headache nurse specialists, to see how you responded to Emgality.  

It is important that you keep a headache diary that clearly shows the days you had a migraine as well as how severe the migraine was, scoring it from 0 to 10 (10 being the worst). The nurse will be able to judge how well the Emgality is working by looking at your diary.  

If you have chronic migraine (more than 15 days a month), you will be able to continue with Emgality if your migraines are at least 30% better than before you started the Emgality.  

If you have episodic migraine (four to 14 migraine days a month), you will be able to continue with Emgality if your migraines are at least 50% better than before you started Emgality.  

A few days before your telephone appointment, please send the photo of your headache diary to [email protected].

Who can I contact for information and advice?

Please contact the headache nursing team at [email protected] for advice. Alternatively, you can call your consultant’s secretary, and they can direct your enquiry.