How can I manage high BP from migraine treatment at 39?

Question

Hello doctor,

I am a 39-year-old female who has been suffering from chronic migraines for over ten years, with approximately 15 to 20 headache days per month. I started receiving monthly CGRP (calcitonin gene-related peptide) inhibitor injections of Erenumab 140 milligrams about four months ago. While my migraine days have reduced to about six to eight per month, I have recently developed elevated blood pressure readings, consistently around 160/100 millimeters of mercury.

I have never had hypertension before, and now my doctor has started me on Amlodipine 5 mg (calcium channel blocker class) once daily. I am concerned whether the migraine injections are contributing to the rise in blood pressure, as I have read that it can be a side effect.

I also take Sumatriptan occasionally during severe attacks, and I am unsure if combining it with high blood pressure is safe.

Please suggest.

Should I discontinue the injections or switch to a different preventive treatment?
Is it risky to continue both CGRP inhibitors and antihypertensive medications together?
I have noticed more palpitations and fatigue lately. Could that be due to either medication?
What is the best way to balance migraine control with blood pressure safety?

I am worried about long-term heart or kidney complications if this continues.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

You have done well in reducing your migraine days with Erenumab (monoclonal antibody class); however, the new-onset high blood pressure (160/100 mmHg) is a known, although uncommon, side effect. Erenumab can raise blood pressure in some individuals, especially after several months of use. Therefore, it is possible that the injections are contributing to your elevated readings.

New high blood pressure may also be linked to Erenumab. In addition, Sumatriptan (triptan class), which you use during migraine attacks, can temporarily raise blood pressure. This is not ideal when your blood pressure is already elevated.

Palpitations and fatigue could be side effects of Amlodipine (calcium channel blocker class), Erenumab, or high blood pressure.

You should not stop Erenumab abruptly. However, you should discuss with your doctor the possibility of switching to a different preventive treatment, such as:

Topiramate (anticonvulsant class).
OnabotulinumtoxinA / Botox (neurotoxin class).
Gepants such as Rimegepant (CGRP receptor antagonist class) generally have less effect on blood pressure.

Continue Amlodipine for now, as it is safe to use with CGRP inhibitors and offers protection to your heart and kidneys from long-term damage.

Ask your doctor if it is safe to continue using Sumatriptan, or consider switching to a non-vasoconstrictive acute medication such as a Gepant or Ditan.

Ensure that your blood pressure is monitored regularly, and request basic heart and kidney function tests to detect any early changes.

I hope this helps.

Thank you.