Erenumab Dosage for Migraine Prevention

An Evidence-Based Narrative Review With Recommendations

Stewart J. Tepper MD; Huma U. Sheikh MD; Carrie O. Dougherty MD; Stephanie J. Nahas MD MSEd; Paul K. Winner DO; Ananda Krishna Karanam PhD; Andrew M. Blumenfeld MD; Ahmad Abdrabboh PharmD MPH; Soeren Rasmussen MD; Jamie L. Weiss PhD; Jessica Ailani MD


Headache. 2022;62(4):420-435. 

In This Article


The cumulative data provide evidence for the numerically higher efficacy of erenumab 140 mg versus 70 mg for a range of outcomes across the spectrum of migraine. Furthermore, this extends to patients with previous preventive treatment failures and with medication overuse, and in preventing/reversing progression to CM. While the recommended starting dosage of erenumab is 70 mg, the data support the rationale for a potential therapeutic gain with an increase to erenumab 140 mg and for initiating 140 mg in selected patients. Finally, there is not a clear therapeutic penalty with using the higher dose, so the dose–response relationship likely favors the use of the 140 mg monthly dose.