Preventive treatment · CGRP biologics
CGRP biologics: the first medications designed for migraine.
Aimovig, Ajovy, and Emgality — what they are, how they work, who they’re right for, and how Wellday gets you on them without the insurance battle.
What they are
The breakthrough that changed migraine prevention.
CGRP biologics are a class of preventive medications that came to market starting in 2018. They were the first medications in history developed specifically to prevent migraines — not borrowed from epilepsy treatment, not adapted from blood pressure medication, not a side-effect benefit of an antidepressant. Designed for migraine, from the ground up.
There are three CGRP biologics currently FDA-approved for migraine prevention:
- Aimovig (erenumab) — the first to market, approved May 2018
- Ajovy (fremanezumab) — approved September 2018
- Emgality (galcanezumab) — approved September 2018
All three are monoclonal antibodies — engineered proteins that target either the CGRP molecule itself or its receptor. They’re given as self-administered injections, and they’ve changed what’s possible for patients who used to be told there was nothing left to try.
How they work
Blocking the chemical that triggers migraine cascades.
Migraine attacks involve a chemical called CGRP — calcitonin gene-related peptide — that spikes during an attack and triggers the inflammation, vascular changes, and pain pathways that produce the migraine experience. Researchers had known about CGRP’s role for decades. Until 2018, no one had a way to block it specifically.
CGRP biologics work in one of two ways:
They block the CGRP molecule itself.
Ajovy and Emgality bind directly to CGRP, neutralizing it before it can attach to its receptor and trigger an attack. Think of it as intercepting the signal mid-flight.
Or they block the CGRP receptor.
Aimovig blocks the receptor that CGRP plugs into — so even if CGRP is released, it has nowhere to land. Think of it as sealing the lock so the key can’t open it.
Both approaches accomplish the same goal: preventing CGRP from triggering migraine. Whether you respond better to one approach or the other is patient-specific, which is why having multiple options matters.
Who qualifies
If you have 4 or more migraine days a month, you’re a candidate.
CGRP biologics are FDA-approved for adults with episodic migraine (4–14 days per month) and chronic migraine (15+ days per month). They’re a particularly good fit for:
Good candidates
- Patients who have 4 or more migraine days per month and aren't currently on a preventive
- Patients who have tried older oral preventives (topiramate, amitriptyline, propranolol) and didn't respond
- Patients who couldn't tolerate the side effects of older preventives — the cognitive fog from topiramate, the fatigue from beta-blockers, the weight gain from amitriptyline
- Patients who have cardiovascular risk factors that make triptans less ideal — CGRP biologics don't constrict blood vessels and have a clean cardiovascular profile
May not be the right fit
- Patients who are pregnant or planning to become pregnant — there isn't enough safety data yet
- Patients with severe cardiovascular disease — your clinician will review this carefully
- Patients with very infrequent migraines (less than 4 days per month) — the cost-benefit math typically favors acute-only treatment
The Wellday assessment is designed to identify candidates accurately. There’s no charge to find out, and no obligation if you’re not the right fit.
What to expect
What treatment actually feels like.
The injection itself. CGRP biologics are self-administered with a small auto-injector pen — similar to an EpiPen or insulin pen. The injection goes into the thigh, abdomen, or upper arm. The first time can feel intimidating; most patients find it routine within 1–2 doses. The whole process takes under a minute.
Dosing schedule
- Aimovig: once monthly
- Ajovy: once monthly, or one larger dose every three months (your choice)
- Emgality: a loading dose of two injections to start, then once monthly
The timeline for results. Most patients begin seeing reduction in migraine frequency within the first month. Full effect is typically reached by month three. The clinical benchmark for “responding” to a CGRP biologic is at least a 50% reduction in monthly migraine days — many patients see significantly more.
What “responding” looks like. A patient who had 12 migraine days per month before treatment and 4–6 afterward is a typical responder. That’s not the same as never having migraines again — but it’s a transformative quality-of-life difference for someone who’s been living around their attacks for years.
If the first one doesn’t work. About 30% of patients don’t respond to the first CGRP biologic they try. This isn’t unusual — different patients respond to different molecules. Switching to another biologic (or to an oral CGRP) often produces results when the first didn’t. Wellday handles those transitions as part of standard care, not as a complication.
Side effects
The honest accounting.
CGRP biologics are notably well-tolerated compared to older preventives — that’s one of their biggest advantages. The most commonly reported side effects:
What you won’t find on this list: cognitive fog, weight gain, drowsiness, sexual side effects. The things that drove patients off topiramate, amitriptyline, and propranolol largely don’t happen with CGRP biologics. That’s the breakthrough.
One important note: safety data on CGRP biologics during pregnancy and breastfeeding is still developing. If you’re trying to conceive, pregnant, or breastfeeding, your clinician will discuss timing carefully.
How Wellday handles it
We do the hard parts. You start treatment.
CGRP biologics are highly effective. They’re also expensive without insurance — list prices run around $700 per month — and almost every commercial insurance plan requires prior authorization before they’ll cover them.
This is the gap where most patients give up.
We submit the prior authorization.
Our clinical partners submit PA requests using documentation pre-populated from your intake. Most PAs are approved within 1–2 weeks.
We handle step therapy if your insurer requires it.
Many plans require you to have tried two older oral preventives before approving CGRP. If you've tried them and they failed, we document that properly and submit. If you haven't, we walk you through which older preventive makes the most sense to try first — and we move quickly to switch you to CGRP once the requirement is satisfied.
We file appeals if denied.
Most denials are overturned with proper documentation. Wellday's clinical team submits appeals as part of standard care — you don't lift a finger.
We coordinate the manufacturer savings card.
All three CGRP biologics have copay assistance programs through their manufacturers. For most commercially insured patients, the savings card brings the out-of-pocket cost to $0–5 per month. Wellday enrolls you in the right program automatically.
We handle annual renewals.
Your PA needs to be renewed every year. We do that for you, in the background, so your treatment never lapses.
Wellday Care is $69/month for the Prevention path. That’s the platform fee. The medication itself is typically $0–5 per month after insurance and savings card coordination.
Common questions
Questions we hear all the time.
Is one CGRP biologic better than the others?
Not in any clinically meaningful way. All three have similar efficacy in clinical trials. The differences come down to dosing schedule (monthly vs. quarterly option), injection device preference, and individual patient response. About 30% of patients who don't respond to one will respond to another, which is why having multiple options matters.
How long do I need to take it?
There's no fixed timeline. Many patients stay on CGRP biologics indefinitely because they continue to work. Some patients gradually taper off after a year or two of stable improvement, with their clinician's guidance — and some need to come back on if migraines return.
Can I take a CGRP biologic and still take a triptan or gepant when I have an attack?
Yes. CGRP biologics are preventive — they reduce how often migraines happen. You'll still have an acute treatment for breakthrough attacks. Gepants and triptans are both compatible.
How do CGRP biologics compare to Qulipta or Nurtec?
The biologics (injections) and the oral CGRP medications target the same chemical pathway. The main differences are how often you take them, how quickly they work, and convenience. Many patients prefer the simplicity of a monthly injection over a daily pill; others prefer the opposite. Both are legitimate choices. We help you decide based on your situation.
What if my insurance won't cover it?
If your commercial insurance denies CGRP after appeal, we'll discuss cash-pay options. The manufacturer savings card typically brings cash-pay cost to around $69/month — same as Wellday Care. If you're on Medicare, Medicaid, Tricare, or VA, the savings card programs don't apply, and we'll be honest about whether Wellday can help in your situation.
Are CGRP biologics safe for pregnancy?
Safety data during pregnancy is still developing. If you're trying to conceive, pregnant, or breastfeeding, your clinician will discuss timing carefully. For most patients, this means stopping the medication before conception attempts — but it's a personal conversation based on your situation.
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From the founder
“I suffered through migraines for two decades before I got real treatment. Wellday is what I wish I’d had — and we’re building it to be seamless and accessible to everyone like me.”
— Jeff Glasco, Founder
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The information on these pages is for general education about migraine and its treatments. It is not medical advice and is not a substitute for evaluation, diagnosis, or treatment by a licensed clinician. Wellday’s care plans are developed individually for each patient based on clinical history, current medications, and personal situation. Always consult with a clinician before starting, stopping, or changing any medication. If you are experiencing a medical emergency or sudden severe headache with new neurological symptoms, call 911 or go to the nearest emergency room.