Galcanezumab (Emgality) injections for migraine

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.  

What should someone do if they experience these?

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) 

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.

Are there any reasons I cannot have Emgality?

You cannot have Emgality if you:

• Have had a transient ischaemic attack (TIA) or a stroke in the past 

• Have had a heart attack or angina 

• Have a bowel disease that makes you more prone to constipation 

• Are pregnant or breast- or chest-feeding. CGRP medication should be stopped at least 5 and a half months before becoming pregnant. It cannot be used while breastfeeding. 

• Have uncontrolled hypertension (high blood pressure, over 150mmHg). Some people’s blood pressure may increase while they are on CGRP therapy. It is important to check your blood pressure monthly, to make sure it remains well controlled. 

What happens after I start using Emgality?

When you start using Emgality, you will be offered a 3-month trial:

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

One week after injection on month 3 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.