CGRP Migraine Medications Sydney | Emgality, Aimovig, Ajovy, Vyepti | Dr Ron Granot
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CGRP Medications for Migraine Prevention

The first migraine-specific preventative class — Emgality, Ajovy and Vyepti are PBS-listed in Australia (Aimovig registered but not PBS-subsidised). Prescribed by Dr Ron Granot at Sydney Headache Centre, Bondi Junction.

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The First Migraine-Specific Preventative Class

Until 2018, every drug used to prevent migraine was repurposed from another indication — propranolol from cardiology, topiramate from epilepsy, amitriptyline from depression, Botox from cosmetics. CGRP monoclonal antibodies are different: they were designed specifically for migraine and act on the actual pain pathway that drives it.

CGRP (calcitonin gene-related peptide) is a small protein released from trigeminal nerve endings during migraine. It causes blood vessel dilation, neuroinflammation, and amplification of pain signals to the brain. CGRP monoclonal antibodies block either CGRP itself or its receptor, preventing the cascade that produces a migraine attack.

The Four CGRP Medications Available in Australia

Three are PBS-subsidised. The fourth (Aimovig) is registered but not PBS-listed, making it substantially more expensive — used rarely as a consequence.

1. Emgality

galcanezumab
Anti-CGRP ligand · PBS
  • Dosing: Monthly subcutaneous self-injection
  • Loading dose: Double dose at first injection
  • Onset: Often within 4–8 weeks
  • Notable: First CGRP mAb PBS-listed in Australia (June 2021). Pen-injector at home.

2. Ajovy

fremanezumab
Anti-CGRP ligand · PBS
  • Dosing: Monthly OR quarterly subcutaneous
  • Onset: Often within 4–8 weeks
  • Notable: Flexibility of quarterly dosing — fewer injections per year.

3. Vyepti

eptinezumab
Anti-CGRP ligand · PBS · IV
  • Dosing: Quarterly intravenous infusion (~30 min) in clinic
  • Onset: Often within days to weeks — the fastest onset of the four
  • Notable: No self-injection. Useful for needle-averse patients or where rapid onset matters.

4. Aimovig

erenumab
Anti-CGRP receptor · NOT PBS
  • Dosing: Monthly subcutaneous self-injection (70 mg or 140 mg)
  • Onset: Often within 4–8 weeks
  • Cost: Private prescription only — substantially more expensive than the PBS-listed agents (~$500+/month at pharmacy)
  • Notable: The only receptor-targeting CGRP mAb. Constipation more common. Used rarely in our practice because cost is prohibitive for most patients when PBS-listed alternatives exist.

PBS Eligibility — Who Qualifies?

The three PBS-listed CGRP mAbs (Emgality, Ajovy, Vyepti) have effectively identical PBS criteria. Eligibility focuses on treatment-resistant chronic migraine.

Patient must meet ALL of the following

  • Chronic migraine — ≥8 headache days per month, documented with a headache diary
  • Adequate trials of ≥3 oral preventative medications from different classes — each at adequate dose and duration, discontinued for inefficacy or intolerance
  • Treatment prescribed by a neurologist (Dr Granot meets this requirement)
  • Not concurrently receiving PBS-subsidised Botox for chronic migraine

Continuation — PBS authority is granted in stages. Initial approval covers a treatment trial; continuation requires demonstrated ≥50% reduction in headache days. Reviews continue at regular intervals.

How CGRP Treatment Works in Practice

1

Pre-treatment baseline

Headache diary documenting frequency, intensity and duration of migraine days over at least 1 month (ideally longer). PBS approval is contingent on a documented baseline.

2

Agent selection

The four agents are broadly similar in efficacy. Selection considers route preference (self-injection vs in-clinic IV), dosing frequency, side-effect profile (constipation history → may avoid Aimovig), and pregnancy plans.

3

PBS authority application

Dr Granot submits the PBS authority application on your behalf. Once approved, the prescription is dispensed at your pharmacy (or for Vyepti, scheduled at an infusion centre).

4

First dose & technique training

For self-injection pens (Emgality, Aimovig, Ajovy), the first dose is often given in the rooms with technique training. Subsequent doses are self-administered at home. Vyepti is administered as a 30-minute IV infusion at a designated infusion clinic.

5

Response assessment

Response is formally assessed after 3 months (PBS minimum) and again at 6 months. Continuing diary entries are essential. PBS continuation requires ≥50% reduction in migraine days at the assessment point.

How They Compare — Choosing the Right Agent

AgentPBS?TargetDosingRouteParticular considerations
Emgality (galcanezumab)✓ PBSCGRP ligandMonthlySC pen at homeLoading dose at start. Easy auto-injector.
Ajovy (fremanezumab)✓ PBSCGRP ligandMonthly OR quarterlySC pen at homeFlexibility — patient can choose dosing frequency.
Vyepti (eptinezumab)✓ PBSCGRP ligandEvery 3 monthsIV infusion in clinicEarliest onset (often days). No self-injection. Useful for needle-averse patients or where rapid onset matters.
Aimovig (erenumab)✗ PrivateCGRP receptorMonthlySC pen at homeNOT PBS-subsidised — substantially more expensive. Constipation more common. Used rarely as a consequence.

CGRP vs Botox — Which to Choose?

For chronic migraine patients meeting both sets of PBS criteria, CGRP and Botox are both reasonable options. Choice depends on individual factors. Read the detailed comparison on our Botox page.

FactorCGRP mAbsBotox
PBS indicationChronic migraine — ≥8 headache days/monthChronic migraine — ≥15 headache days/month with ≥8 migraine days
FrequencyMonthly or 3-monthlyEvery 12 weeks (3-monthly)
RouteSC self-injection or IV infusion31 IM injections in-rooms
Time to response4–8 weeksOften by cycle 2 (24 weeks)
Best suited forHigh-frequency episodic AND chronic migraineChronic migraine with medication-overuse component

Frequently Asked Questions

What are CGRP medications and how do they work? +
CGRP (calcitonin gene-related peptide) is a key chemical messenger involved in migraine pain. CGRP monoclonal antibodies block either CGRP itself (galcanezumab, fremanezumab, eptinezumab) or the CGRP receptor (erenumab). They are administered by injection (subcutaneous monthly or intravenous quarterly) and prevent migraine attacks rather than treating them when they occur.
Which CGRP medications are PBS-listed in Australia? +
Three are PBS-listed: Emgality (galcanezumab) — monthly SC self-injection; Ajovy (fremanezumab) — monthly or quarterly SC; and Vyepti (eptinezumab) — quarterly IV infusion in clinic. A fourth agent, Aimovig (erenumab), is registered for use in Australia but is NOT PBS-subsidised, making it considerably more expensive. As a consequence, Aimovig is used rarely in our practice when PBS-listed alternatives exist. PBS subsidy criteria are essentially the same across the three PBS-listed agents.
Who is eligible for PBS-subsidised CGRP medications? +
PBS criteria require: chronic migraine with at least 8 headache days per month; failed adequate trials of at least 3 oral preventatives from different classes; treatment prescribed by a neurologist; not currently receiving Botox under PBS for chronic migraine; and a headache diary documenting baseline frequency. Authority approval is required and continuation depends on demonstrating ≥50% reduction in headache days.
How quickly do CGRP medications work? +
Many responders notice improvement within 4–8 weeks of the first dose, which is faster than Botox (where response is typically seen by cycle 2 at week 24). PBS guidelines require 3 months of treatment before formally assessing response.
What are the side effects? +
The most common are injection-site reactions (redness, soreness). Constipation is more common with Aimovig (erenumab). All four agents can rarely cause hypersensitivity reactions. Unlike oral preventatives, CGRP mAbs have few systemic side effects — they don't cause sedation, weight changes, or cognitive slowing typically associated with topiramate or amitriptyline.
Can I use CGRP alongside Botox? +
Not concurrently under PBS — patients must choose one, although switching between them is permitted under PBS authority rules. Some private (non-PBS) use of both has been described internationally but is not subsidised in Australia.
What happens if it doesn't work? +
PBS continuation requires documented ≥50% reduction in migraine days. If inadequate, treatment is discontinued and an alternative — including Botox or a different CGRP agent — may be tried. A different CGRP agent is sometimes effective when one has failed, particularly when switching between receptor antagonist (Aimovig) and ligand antagonists.
What about pregnancy and breastfeeding? +
CGRP mAbs are not recommended in pregnancy. Because of their long half-life (several months), washout is required before planned conception — typically 5 half-lives, which for most CGRP mAbs means stopping at least 5 months before trying to conceive. Discuss the timeline in advance if you are considering pregnancy.

Related: Migraine overview · Botox for chronic migraine · Headache diary tool · For GPs

Important: This page is general health information for adults living in Australia and is not a substitute for individual medical advice. CGRP medications have specific PBS eligibility criteria and are prescribed only after a comprehensive consultation. Treatment decisions are made on an individual basis with your treating doctor.

Considering CGRP for Your Migraines?

Book a consultation with Dr Ron Granot to assess your PBS eligibility and choose the right agent for you.

Book a Consultation
Call Us02 9388 0615
LocationSuite 301, Bondi Junction
Emailreception@eastneurology.com.au

Last reviewed: 25 May 2026 by Dr Ron Granot, FRACP — Consultant Neurologist, East Neurology, Bondi Junction.

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