Migraine Treatment

Migraine treatment for patients who’ve been told to just live with it.

CGRP therapy is the first class of preventive medications developed specifically for migraine, not repurposed from blood pressure or epilepsy drugs. The American Headache Society now recommends it as first-line treatment. For many patients who haven’t responded to other options, it is the one that finally works. ANSA Neurology offers CGRP therapy in Glendale, serving patients throughout Los Angeles.

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Board certified neurologist · Injectable & oral CGRP options · Insurance coordination

50%

Reduction in monthly migraine days for many patients

Clinical trials of CGRP monoclonal antibodies consistently showed at least 50% reduction in monthly migraine days in roughly half of patients treated, results most had not achieved with older preventive medications.

2024

AHS names CGRP first-line preventive therapy

In 2024, the American Headache Society updated its guidelines to recommend CGRP-targeted therapies as a first-line option for migraine prevention, the first time a targeted migraine therapy has held that status.

Now accepting migraine patients

Understanding Migraine

Migraine is a neurological condition. It deserves neurological care.

Migraine is the third most prevalent illness in the world and a leading cause of disability. It is not a headache disorder that happens to be severe, it is a complex neurological condition involving changes in brain activity, neurotransmitter release, and vascular response that can affect vision, sensation, speech, and coordination in addition to pain.

Many patients with migraine have spent years cycling through general practitioners and neurologists without finding an approach that meaningfully reduces their frequency or severity. Often, this is not because their condition is untreatable, it is because they have not yet had access to the right evaluation, the right diagnosis of their specific migraine subtype, or the right generation of treatment.

CGRP therapy, the most significant advance in migraine treatment in decades, has changed what is possible for many of these patients. But effective migraine care also requires accurate diagnosis, understanding of triggers, and a comprehensive approach to both prevention and acute treatment.

Episodic migraine

Fewer than 15 headache days per month. CGRP therapy is indicated and highly effective for patients with episodic migraine who benefit from preventive treatment.

Chronic migraine

15 or more headache days per month, with at least 8 being migraine. CGRP therapy is highly effective and is often the turning point for patients with chronic migraine.

Medication overuse headache

When acute medications are used too frequently, headache can paradoxically worsen. CGRP therapy can help break this cycle without requiring hospitalization.

CGRP Therapy

The first preventive treatment built specifically for migraine.

CGRP stands for calcitonin gene-related peptide, the molecule most responsible for triggering and amplifying migraine attacks. CGRP is released during a migraine, causes vasodilation, activates pain receptors in the trigeminal nerve, and sustains the cascade of events that makes a migraine so debilitating. CGRP medications were engineered specifically to interrupt this process.

Injectable CGRP Monoclonal Antibodies

Monthly or quarterly injection

CGRP monoclonal antibodies are large-molecule medications that bind to CGRP or its receptor, preventing it from triggering attacks. They are administered as subcutaneous injections using an auto-pen device, similar to insulin pens, that can be self-administered at home after the first dose, or given in office.

Monthly options provide consistent, steady-state prevention. A quarterly subcutaneous option is also available for patients who prefer less frequent dosing. An intravenous quarterly option provides the medication through an infusion for patients who do better with that route.

Monthly subcutaneous injection Quarterly subcutaneous option Quarterly IV infusion option Home self-injection available

Most major insurance plans and Medicare cover CGRP monoclonal antibodies. ANSA coordinates prior authorization and assists with access programs when needed.

Oral CGRP Medications (Gepants)

Daily pill for prevention, or on-demand for acute attacks

Gepants are small-molecule CGRP receptor antagonists that can be taken orally. Unlike the monoclonal antibodies, certain gepants have received FDA approval for both preventive daily use and acute treatment, meaning a single medication can address both the prevention of attacks and the treatment of an attack when it occurs.

Oral gepants are a particularly useful option for patients who prefer not to inject, who have had side effects with injectable CGRP medications, or whose migraine pattern benefits from a combined acute and preventive strategy. They are also well-tolerated and have a favorable cardiovascular safety profile compared to older migraine treatments.

Daily preventive option Acute treatment option Some approved for both uses No injection required

Dr. Akopian will help identify the right CGRP option based on your migraine frequency, pattern, and history with other treatments, and will manage prior authorization with your insurer.

The ANSA Approach

Migraine care that addresses the full picture.

CGRP therapy is the cornerstone of modern migraine prevention, but effective migraine care is not a single medication. It is a comprehensive approach that begins with accurate diagnosis and extends through acute treatment, preventive strategy, trigger management, and ongoing monitoring.

Accurate diagnosis first

Not every severe headache is a migraine, and not every migraine is the same. Dr. Akopian identifies your specific migraine subtype, with or without aura, chronic vs episodic, hemiplegic, vestibular, because subtype affects treatment selection. He also screens for secondary causes that require urgent attention.

Preventive treatment

For patients with frequent, disabling, or poorly controlled migraines, preventive medication reduces how often attacks occur. CGRP therapy is the most effective preventive available and is now first-line. Other options including topiramate, propranolol, amitriptyline, and onabotulinum toxin A are available when appropriate.

Acute treatment

Preventing migraines and treating them when they occur are separate strategies that work best in combination. Dr. Akopian will optimize your acute treatment plan, ensuring you have an effective rescue medication, understand how and when to use it, and are not at risk for medication overuse headache.

Trigger management & monitoring

Sleep disruption, dietary triggers, hormonal changes, stress, and environmental factors all contribute to migraine frequency. Identifying your specific triggers and building strategies around them reduces the overall burden of the disease. Dr. Akopian tracks your response to treatment over time and adjusts the approach as needed.

When to Seek Urgent Care

Most migraines are not dangerous. These symptoms are different.

Migraine is a benign neurological condition, but certain headache presentations are warning signs of something more serious requiring immediate evaluation. If you experience any of the following, go to the nearest emergency room or call 911, do not wait for a routine appointment.

Thunderclap headache

A headache that reaches maximum intensity within seconds, the "worst headache of your life" that comes on without warning. This is a medical emergency until proven otherwise.

Headache with neurological symptoms

New weakness, numbness, facial drooping, slurred speech, vision loss, or confusion accompanying a headache may indicate a stroke. Call 911 immediately.

Headache with fever and stiff neck

This combination can indicate bacterial meningitis and requires immediate emergency evaluation. Do not take pain medication and wait to see how it feels.

A new type of headache after 50

New-onset headache in patients over 50 without a prior headache history warrants prompt evaluation to rule out secondary causes including giant cell arteritis and mass lesions.

Headache that worsens when lying down

Headaches that are consistently worse in the morning or with positional changes, especially if accompanied by vomiting, may reflect elevated intracranial pressure.

Progressive worsening over weeks

A headache that has been consistently worsening over days to weeks without relief, especially in someone without a prior headache history, requires formal evaluation.

Frequently Asked Questions

Common questions about CGRP therapy and migraine care.

How quickly does CGRP therapy work?

Many patients notice a reduction in migraine frequency within the first month. The full effect of CGRP monoclonal antibodies typically develops over 3 to 6 months. Oral CGRP medications used acutely can begin working within a couple of hours of taking a dose. Because individual responses vary, Dr. Akopian monitors your progress and adjusts the approach if needed. Most patients who respond to CGRP therapy do so within the first 3 months.

Does insurance cover CGRP medications?

Most major insurance plans, including Medicare and many commercial plans, cover CGRP monoclonal antibodies and oral gepants, typically requiring prior authorization. The criteria usually include a documented diagnosis of migraine and evidence that at least two prior preventive medications were tried without adequate response. ANSA assists with prior authorization and can also connect you with manufacturer patient assistance programs if coverage is denied or cost-sharing is a barrier.

I’ve tried other preventive medications. Will CGRP therapy work for me?

This is exactly the patient population CGRP therapy was designed for. Clinical trials specifically enrolled patients who had not responded adequately to standard preventive medications, and the results were consistently positive. Because CGRP medications target the specific mechanism that drives migraine, rather than borrowing a mechanism from another condition, they work through a completely different pathway than older preventives. Many patients who had poor results with topiramate, propranolol, or amitriptyline respond well to CGRP therapy.

Is CGRP therapy safe long-term?

CGRP medications have now been in clinical use since 2018 and have an established safety profile. The most commonly reported side effects are injection site reactions and, in some patients, constipation with erenumab. Serious adverse events are rare. Long-term safety data from clinical trials and real-world use are reassuring. CGRP is a naturally occurring molecule with important roles in cardiovascular regulation, so Dr. Akopian will review your cardiovascular history as part of prescribing. Patients with recent cardiovascular events are evaluated on a case-by-case basis.

What is the difference between CGRP monoclonal antibodies and gepants?

CGRP monoclonal antibodies are large-molecule biologics given by injection that provide sustained, continuous CGRP blockade for prevention. They are dosed monthly or quarterly and are specifically for preventive use. Gepants are small-molecule CGRP receptor antagonists taken orally. Some gepants are approved for acute treatment of an active migraine attack; others are approved for daily preventive use; and some carry approval for both. Gepants are taken as-needed or daily and have a shorter duration of action. The choice between them depends on your migraine pattern, preference for delivery method, and other clinical factors.

Can I still take my usual migraine medication while on CGRP therapy?

In most cases, yes. CGRP preventive therapy does not replace acute medications, it reduces how often you need them. Triptans, NSAIDs, and other acute treatments can generally be used alongside CGRP preventive therapy. The exception is combining gepants used acutely with certain other gepants used preventively, which Dr. Akopian will review with you. The goal of CGRP prevention is to reduce migraine frequency to the point where acute medications are needed far less often, which also reduces the risk of medication overuse headache.