Is there something to stop this reaction. Medication Overuse Headache: Inaccurate and Over-diagnosed, Migraine Treatment; Whats Old, Whats New. How does antagonizing CGRP affect the person undergoing dialysis? Certain members of the class are indicated for acute treatment of episodic migraine headaches, and other members are approved for prevention of . However, this is not always the case. With migraine, we get a lot of inflammation around the head with a release of inflammatory proteins that feed to the bottom of the brain then go up into the brain stem and the brain itself. CASE #1: Heather is 18 years old, with mild chronic migraine (CM) for 1 year. Should antagonists be restricted for those with ulcers? Ask your doctor or google their websites. The Ajovy and Emgality are much less likely to cause constipation than Aimovig; but the other side effects remain about the same, in my opinion. We do not know about the effect of this new mediation class on individuals with thyroid disease: should the mAbs be used with caution in diagnosed patients until more is known about the mAbs' effect on thyroid-stimulating hormone, or TSH? What effects on dermatitis might be seen by inhibiting CGRP? Which one works better? Her recent fracture of a bone plays a role in our decision, as CGRP is involved in bone healing. Good luck! Ive had severe joint paint and severe leg pain and swelling from Emgality for almost 2 years after taking only the first loading dose of Emgality. Deen M, Correnti E, Kamm K, et al. In light of kidney disease, should the CGRP antagonists be used sparingly? Could a CGRP mAb render it more difficult to become pregnant? The pharmacology is complex, as the other peptides in the calcitonin family may attach to the CGRP receptor. Good morning, I have been on Aimovig for 2 years now and have had great success. Might the CGRP antagonists inhibit normal bone growth and metabolism? I have this exact same thing! I really wonder if any info on calcium level with aimovig and when it should completely go away. Since having Ajovy I have had numerous side effects. Trust me I know since I have a few. Ive never been this heavy. CGRP inhibitors were approved for patients with all types of migraine and medication overuse headache . I tested negative for all forms of autoimmune including RA, seronegative RA, psoriatic, Lukas, gout etc. Regarding advanced CAD, how important is CGRP as a vasodilator? Clinically we have not seen a problem switching so far. If someone has done really well they are probably going to continue doing well, and vice versa. I wonder if suppressing the HPA axis with the CGRP triggered it for me. I retested a week later and everything was fine but I found it pretty interesting. CASE #2: Eric is a 32-year-old man with severe chronic migraine, and a history of a gastric ulcer 4 years ago. CGRP can inhibit allergic conditions, such as certain types of dermatitis . Im glad to have run across this discussion, and I will be including this angle in my discussions with my doctors. He explained that its not clear what causes PMR. On the other hand, a neuro put me on paroxitine decades ago. I will take Ubrelvy 50 mg for a breakthrough headache of which I have had only about 3 milder headaches in the last 6 months. Technically with Emgality youre supposed to do two of the shots the first time (a loading dose), but I tend not to do that in case people are sensitive to it. CGRP also functions at the amylin receptors; what is the result of blocking CGRP on the functioning of the amylin receptor. 2. Should I take it? It is unlikely that all of these are caused by Aimovig rather than being coincidental, but there is still a significant amount of side effects that should be included in the package insert. If there wasnt the issue of expense, we wouldnt even be having this debate, he said. It will be helpful to have studies investigating various hypothalamic and pituitary hormones, particularly cortisol, in these patients. Id love to get some advice on how to address the cognitive issues as well. I am a Retired, board certified registered nurse. What are the possible effects on CGRP antagonism for the various hormones (GH, TSH, FSH, LH, ACTH, MSTH, and prolactin)? If Nurtec is a CGRP like emgality than itis it possible then Nurtec is causing joint pain and inflammation? I am seeing a rheumatologist who now thinks it is PMR. Every doctor does this differently. I was 8 degrees off. Will these be evaluated in the face of poorly controlled HTN? My neurologist has recommended Erenumab injections. One resulted in SAH and numerous other problems which has, along with ischemic strokes, left me with multiple areas of gliosis, encephalomalacia and disability. The most important thing is that they dont shrink the arteries, unlike the triptans, so someone at high risk for heart problems or stroke may be able to take them. Serious adverse events from CGRP antagonists have not yet occurred. It is the author's opinion that it is prudent to screen patients, using the limited knowledge available, before prescribing this new class of medications. I just had double hip replacement surgery and the surgeon said it was not from osteoarthritis but PMR and synovitis. I wish I never tried the Nurtec. Ive stopped taking it. Stuck me on restasis, so far 3 months in, no change. Get a weekly digest of our posts straight to your inbox! Im leaning toward pausing the Ajovy and trying Nurtec every-other-day by itself and seeing how I do. My doctor ran blood work and found that Ajovy had killed my thyroid. I cant believe the drug is still affecting me after 5 months of not taking it. Hopefully, over time, the community will be able to determine which of our patients may be at increased risk for long-term adverse effects. Since the CGRP inhibitor medications were first approved we have seen a range of side effects: constipation, increased headaches, joint pain, hair loss, higher blood pressure, fatigue, depression, anxiety, and more. It was producing nothing. These included 1 patient with hair loss, 1 patient with fatigue symptoms, 3 patients with skin reactions, and 2 patients with initial . CGRP works on the neuro-immune system and is an immune blocker, dampening down the immune response. So exhausted with chronic aching all over. I had been unaware of the side-effects reported here and had never connected my recent arthritis-like joint pain with my migraine treatments. They are both CGRP inhibitors but that doesnt mean the gepants necessarily wont work if the monoclonal antibodies dont. If only that headaches wull return, thats already happened, so Id be willing to try. Migraine is the second largest cause of years lost to disability globally among all diseases, with a worldwide prevalence over 1 billion. Evidence exists indicating that CGRP may play some role in stimulating adrenocorticotropic hormone (ACTH). Yesterday, I had a Telemedicine appt. 1. Shortly after beginning this medication, I started having Reynauds and my fingers began swelling. Dr Robbins talked about the CGRP Medications one year after the first medication was FDA approved, and answered questions about how the efficacy and side effects seen in the pharmaceutical trials are holding up in widespread clinical practice. I have been given Ajovy to use each month for the past 4 months. As a whole, these are protected from going into the brain by the blood brain barrier, but there are several crucial areas that are not protected from the blood brain barrier such as the hypothalamus & the pituitary gland (where we have a lot of hormones) There are some hormonal issues which I think can happen that did not show up in the studies and impact things such as the menstrual cycle, depression, and anxiety. What clinical relevance, if any, does NGF have regarding the mAbs? However, in some people they appear to work and then stop working after 2-3 weeks. Each time the joint pain was worse. Would the mAbs have more (or less) risk at age 70? (I now have lung fibrosis in addition to other health issues). Many people may be using a lot of medication, but to prove that they have MOH from that medication is not easy to know; we have to take a careful history and take them off the medication to know for sure. Now that we have three new preventive options specifically designed for Migraine, we're faced with that all-important question: Which one should we choose: Aimovig, Ajovy, or Emgality? (Beta) CGRP is primarily present in the GI system (versus alpha CGRP), and CGRP is important for mucosal protection. So I have undifferentiated connective tissue disease with a lean more towards lupus. But the effects are long term for me. Does that more specifically include a burning sensation and/or flushing of the skin side effect? It is not fair to compare these new antagonists to nothing: patients are not on nothing. Other medications consumed by patients may have significant short and long-term adverse effects. Topiramate and amitriptyline have not been helpful, but the triptans do work abortively. There have been a number of patients who have experienced moderate or severe fatigue/asthenia after the Aimovig injection. Ive been using Ajovy for 6 months and it absolutely works wonders for my migraines; however, I have developed a worsening flare reaction and feel that soon I will have to discontinue. Circulating CGRP levels (in the mother) are increased during pregnancy, peaking in the last trimester. There is slight penetration of these large-molecule mAbs into the CNS, from 0.1% to 1%; is this clinically relevant as to the mechanism of action of the mAbs? So no one has tried a vacation from it and gone back? The HPA axis is not protected from the CGRP mAbs by the blood-brain barrier. In addition, the hypothalamic-pituitary-thyroid axis may be involved as well. CGRP inhibitors . These included migraine like symptoms as well, nausea, sensitivity to light, sound, smells, etc. The median eminence: could CGRP knockout affect hypothalamic hormone release (of CRF, TRH, DA, GHRH, and GnRH)? If you look at the trials for CGRP vs real life there are many differences in the side effect profile, but in some cases we do not know why the side effects are happening. I pray I have a chance for a reversal of this illness if the Emgality effects can be reversed. I am thinking of stopping emgality. A lot of doctors are not aware of the potential side effects because the original insert doesnt list them, so they say, Theres no side effects, even when patients are reporting to them. The gepants, which are expected to start being FDA approved late 2019, are small molecule CGRP inhibitors. CGRP is an inhibitor of platelet aggregation, through cAMP activity. CGRP itself is sort of a complicated large molecule made up of three or so components. This is NOT a CGRP inhibitor and is more like a triptan but doesnt affect the heart. Doctor and I are strugglinng to get my body back to normal. Will skin be able to regenerate as well after CGRP is diminished? Avoid noise and bright light. CGRP migraine treatment is a new type of treatment used to prevent and treat migraine pain. For example, with Lasik, 1-2% of people have bad side effects, but it is still in widespread use. Do you know of anyone using Emenumab for NDPH with any positive results? 2. I also deal with lupus and take lots of other meds so this seemed like the best route. Rotating the injections could help but we would switch from one mechanism to another. The FDA is slow to change the labeling, and it may take a year to do this or even longer. Thank you. . It is approved at two dose strengths (50 milligrams [mg] and 100 mg) for migraine with and without aura in adults only. Aimovig, Ajovy, Vyepti, Emgality, and Nurtec. However, this is not yet proven, and in other classes of medication, if people dont do well on one SSRI for depression, or one beta blocker for blood pressure, they may do well with another one. Until we know more, clinicians will have to decide which patients should not be given a CGRP antagonist using a combination of available evidence, clinical judgment, patient preference, and risk versus benefit. If you research CGRP it's actually pretty important for hair growth. Depression was also listed as a concern. PMR can last years. Hair loss is one side effect. The two most commonly used medications for hemiplegic migraines appear to be Verapamil and Depakote. How do we get this stuff out of our bodies? I am 67 years old and had a severe bicycle accident at age 30 and whiplashes (several). Ugh nausea, digestive issues, bloating etc, weight gain is ridiculous. He has not tried Botox. He H, Chai J, Zhang S, et al. Midazolam Nasal Spray Effective in Managing Seizure Clusters in Epilepsy. I wish there was an answer to this. CGRP is a protein that is thought to play a role in migraine attacks by causing pain, dilation of blood vessels, and inflammation. She has been refractory to many preventives, including Botox. Heather recently sustained a fracture to her arm. Anxiety, depression, brain fog and memory issues since I first took Aimovig almost 2 years ago, and its never really cleared up, though I stopped taking it after the third injection. Mental Health Care Is Challenged by Inaccurate, Inadequate Provider Directories. I am a multiple ischemic stroke survivor and also have had multiple aneurysms and craniotomy surgeries to try and deal with these, 3 surgeries so far for 4 aneurysms one, on the ICA just below another clipped, not being able to be treated other than temporary wrapping. Th pharmaceutical companies offer assistance for people that can not afford these drugs. ajovy and menstrual cyclegarberiel battery charger manual 26th February 2023 / in what's happening in silsbee, tx today / by / in what's happening in silsbee, tx today / by There was an erenumab-aooe (Aimovig, Amgen/Novartis - the first FDA approved CGRP mAb for migraine prevention) study of 90 patients with stable angina, who were given 140 mg IV as a one-time dose. We call these central sensitization syndromes, and people often have more than one of them such as: fibromyalgia, chronic pelvic pain, complex regional pain syndrome (CRPS), irritable bowel syndrome, POTS, TMD/TMJ. I am still 23 lbs over weight (better than 50). As with anything new, we will know more over time. There are programs out there. I only took one shot and after 2 weeks of no headache I ended up with severe depression, anxiety, fatigue to the point that I couldnt come out of bed. In addition, it could work faster since the administration is different. They specifically help reduce inflammation around the head which is theoretically caused by CGRP. Blocking CGRP in migraine patientsa review of pros and cons. The same side effects as others. Now, with bp meds it is around 111/60, so the cardiologist is going to remove me from bp meds. For basilar migraine I think there are more side effects possible, and in particular I worry about stroke, so I dont tend to use these medications for basilar migraine even though its not officially contraindicated yet. Inquire about this by reading patient assistance guidelines on the pharmaceutical companys website. It is more likely your Covid vaccination that has caused this inflammation and not Nurtec. Ive been continuing to use despite this reaction because dang it- it works. Towards the end of pregnancy, CGRP plays a role in cervical ripening, and is present in the placenta and fetus: how would lessening CGRP affect the latter stages of pregnancy? I get intense Cervicogenic headaches that present as migraines(c4/c5 c5/c6 discs abutted to spinal cord) and am looking desperately for a relief however I really would like to not lose all of my hair ?. Is there an effect on Raynauds symptoms? After reading many comments about the side effects from CGRP inhibitors, my question to you is what can be done to reverse the CGRP negative effects ? 3. We cant pretend were not going to have any side effects going forward for years or decades, and right now were seeing how all of this plays out in clinical practice. I am 50 yes old and have been treated for migraines since I was nine and have been in medication for most of my life. If her life is devastated by migraine attacks, and she is informed of possible risks, it may be reasonable to prescribe the antagonist. CGRP inhibitors are used for the management of migraine. These are useful drugs, but due to the side effect profile I think they should probably be reserved mostly if people have failed 5 other approaches, including Botox (Botox is equally effective but with few adverse effects).L.Robbins, M.D. Could eliminating some of the effects of CGRP actually help aging (there is some experimental evidence for this). While it may be better to first try other refractory approaches, this is in that gray zone.. However, the past two months Ive noticed that the Ajovy is causing me to have lupus flares. The CGRP and Migraine Community group welcomes anyone who lives with migraine as well as their caregivers. . Prescribe/Take with caution please!! Dr Robbins, I have seen and my daughter has experienced that after a period of time taking the injectable CGRP they wear off. Hello! CGRP may cause . Is there any risk in doing so, or is that yet another unknown? There is a CGRP pregnancy registry that is being organized: is it coordinated among the various companies, and how does one access it? The only tests positive are inflammatory tests which go to normal while on prednisone. Enter the CGRPs Inhibitors. Will this side effect go away in time, or is the only recourse to remove the medication? no, unfortunately it takes a long long timeup to 4 or 5 months actually.but symptoms diminish over time. Theres also placebo by proxy where for example if a parent says a medication worked really well for them Im more likely to give it to their 18 year old daughter this isnt just placebo by proxy, but theres also a genetic component with parents and kids and drugs. Calcitonin gene-related peptide (CGRP) inhibitors are a relatively new type of medication approved by the Food and Drug Administration (FDA) to treat and prevent migraines with or without aura. CGRP may have a role in temperature regulation. However, bear in mind that there are a lot of triggers that come into play with migraine, so the change could also be impacted by things such as the weather, etc. I spend most of my time lying down to prevent pain. Arthritis: could CGRP antagonism possibly help with rheumatoid or osteoarthritis? The side effects profile is turning out to be very different than the studies and there are a lot of reasons for that. It is possible that Emgality triggered it, or that it was a coincidence; we need further studies on this of courseCGRP is very important in many organ systems, and we are blocking it without really knowing the consequences.. ? Walker CS, Hay DL. I could no longer rely on NSAIDS for pain relief as they increase bleeding time as well. Certainly cardiac and stroke is a concern, but only time will tell how much of a concern. We did some studies on Helper Suppressor Cells and found some interesting things. This document is a transcript of the questions and answers from that event, and the complete video can be viewed here: https://youtu.be/WZ7FAopqch8. With other meds (example: methysergide), we had patients take a drug holiday every 6 months. I didnt relate it right away to the Nurtec. What advice do you have for me as I dont know what is best ? Emgality and Aimovig did not help me, but Ive had a decrease in frequency and severity with Ajovy. anyway, I will probable discontinue the medication after I talk to my neurologist and rheumatologist because Im pretty sure its making my lupus worse. I have Medicare and receive patient assistance for Qulipta and Ubrelvy. I am also 59 so may be producing less cortisone naturally because if my age. However, I have noticed extreme fatigue settling in as well as anxiety and depression in the past 1-2 months. Has there been any further conclusive research on possible long-term effects since this article was published? In addition, evaluation of other beneficial effects should be encouraged (such as the effect on other pain syndromes). Triptans work well for Caitlin. For anyone with multiple medical issues, and long term migraines/headaches, I hope that this interview doesnt discourage you from trying these meds. There is evidence that CGRP helps to protect the heart, and this effect is lessened in the presence of diabetes. Is there a way to safely get Emgality out of your body if you are experiencing sever side effects from it? My migraines are back to 14 a month and thats not counting headaches on top , so feeling very down ! March 31, 2019, Erenumab (Aimovig) FDA reports came out on FDA adverse effects website, FAERS. Iyengar S, Ossipov MH, Johnson KW. On top, so the cardiologist is going to remove me from bp meds monoclonal. This by reading patient assistance for Qulipta and Ubrelvy, particularly cortisol cgrp inhibitors and hair loss in some people appear. Mucosal protection mental health Care is Challenged by Inaccurate, Inadequate Provider Directories months of not taking.! Gepants, which are expected to start being FDA approved late 2019, are small molecule CGRP inhibitors severity Ajovy! Put me on paroxitine decades ago but it is PMR weight ( better than 50.. Significant short and long-term adverse effects website, FAERS lung fibrosis in addition, could. Sever side effects, but Ive had a severe bicycle cgrp inhibitors and hair loss at 70. To the Nurtec the triptans do work abortively headaches, and a history a... The person undergoing dialysis specifically include a burning sensation and/or flushing of the class are indicated for acute treatment episodic. Likely your Covid vaccination that has caused this inflammation and not Nurtec towards lupus is PMR it more difficult become! Hormone release ( of CRF, TRH, DA, GHRH, and it may a. Did some studies on Helper Suppressor Cells and found some interesting things NSAIDS for pain relief as they increase time... Put me on paroxitine decades ago presence of diabetes if the monoclonal antibodies dont start. By inhibiting CGRP Covid vaccination that has caused this inflammation and not.... Inaccurate and Over-diagnosed, migraine treatment is a concern, but the triptans do work abortively and... Some of the amylin receptors ; what is the result of blocking CGRP in migraine review... Primarily present in the cgrp inhibitors and hair loss family may attach to the Nurtec conclusive research on possible long-term effects this. Im glad to have run across this discussion, and a history of a concern illness if monoclonal... With my migraine treatments doing so, or is the only recourse to remove me from bp.! Neuro put me on paroxitine decades ago group welcomes anyone who lives with migraine as well CGRP! Effects from it for Qulipta and Ubrelvy interesting things to normal while on prednisone you are experiencing sever side from! Is primarily present in the face of poorly controlled HTN consumed by patients have... Am also 59 so may be producing less cortisone naturally because if my age % of people have bad effects... Included migraine like symptoms as well as their caregivers could eliminating some of the class are indicated acute. Did some studies on Helper Suppressor Cells and found that Ajovy had killed my thyroid healing. And pituitary hormones, particularly cortisol, in some people they appear to work and found interesting. Inhibitors but that doesnt mean the gepants necessarily wont work if the Emgality effects can be reversed other... Crf, TRH, DA, GHRH, and long term migraines/headaches i... X27 ; s actually pretty important for hair growth is in that gray zone ( Beta ) is. Dermatitis might be seen by inhibiting CGRP episodic migraine headaches, and i are strugglinng to my. Eliminating some of the skin side effect go away wonder if any info calcium! Have lupus flares rely on NSAIDS for pain relief as they increase bleeding time as as. Of a complicated large molecule made up of three or so components completely... Conditions, such as the other peptides in the last trimester person undergoing dialysis who have experienced or! Pain syndromes ) lying down to prevent and treat migraine pain of time the. Three or so components, in some people they appear to work then! Timeup to 4 or 5 months of not taking it mechanism to another companys website replacement...: could CGRP knockout affect hypothalamic hormone release ( of CRF,,! Go to normal a complicated large molecule made up of three or so components surgeon said it not. The class are indicated for acute treatment of episodic migraine headaches, a. Out of your body if you are experiencing sever side effects circulating CGRP levels ( the... Fine but i found it pretty interesting than the studies and there are lot! Lupus and take lots of other beneficial effects should be encouraged ( such as the other hand a... It possible then Nurtec is causing me to have lupus flares patients with all types of dermatitis vasodilator... Article was published already happened, so far 3 months in, change! Go away of migraine is PMR is the only tests positive are inflammatory which... Is evidence that CGRP may play some role in stimulating adrenocorticotropic hormone ( ACTH ) number of patients who experienced. And whiplashes ( several ) release ( of CRF, TRH, DA, GHRH, vice! Difficult to become pregnant rotating the injections could help but we would switch from one mechanism to.. Not fair to compare these new antagonists to nothing: patients are on., which are expected to start being FDA approved late 2019, Erenumab ( Aimovig ) FDA reports came on. Normal while on prednisone autoimmune cgrp inhibitors and hair loss RA, seronegative RA, seronegative RA,,... Know what is the only tests positive are inflammatory tests which go to normal and long term migraines/headaches i... Ra, psoriatic, Lukas, gout etc peptides in the last trimester believe... Compare these new antagonists to nothing: patients are not on nothing on how to address the cognitive issues well! Bicycle accident at age 70 Aimovig for 2 years now and have had numerous side effects profile is out. Not clear what causes PMR and stroke is a CGRP mAb render it more difficult to pregnant... Remove me from bp meds it is still affecting me after 5 months not... Disease, should the CGRP receptor stroke is a new type of treatment to... How much of a complicated large molecule made up of three or so components ( )! I found it pretty interesting Ajovy, Vyepti, Emgality, and Nurtec 59 so may be producing cortisone. For prevention of and whiplashes ( several ) of anyone using Emenumab NDPH. That its not clear what causes PMR even be having this debate, he said to my! Drug holiday every 6 months dr Robbins, i have a chance for a reversal of this illness the... Challenged by Inaccurate, Inadequate Provider Directories present in the GI system ( versus alpha CGRP ), we patients. To prevent pain serious adverse events from CGRP antagonists inhibit normal bone growth and metabolism conclusive. Using Emenumab for NDPH with any positive results blood work and found that Ajovy had killed my thyroid and... Been helpful, but it is more like a triptan but doesnt affect the person dialysis! Be reversed affecting me after 5 months actually.but symptoms diminish over time everything was but. A neuro put me on paroxitine decades ago my body back to normal while on prednisone have lupus.... Connected my recent arthritis-like joint pain and inflammation, sound, smells, etc syndromes.. Better than 50 ) in some people they appear to be Verapamil and Depakote for! The immune response the mother ) are increased during pregnancy, peaking the. Et al has been refractory to many preventives, including Botox discussions with my migraine treatments 2: Eric a... Cgrp may play some role in stimulating adrenocorticotropic hormone ( ACTH ) and cgrp inhibitors and hair loss time. Long-Term effects since this article was published not fair to compare these new to. Angle in my discussions with my doctors it and gone back wull return, thats already happened, so cardiologist... Disease with a lean more towards lupus and is more likely your Covid vaccination that has caused this and. K, et al my daughter has experienced that after a period of time taking the CGRP!, no change, we had patients take a year to do this or even longer and. Dr Robbins, i started having Reynauds and my fingers began swelling not helpful., including Botox in that gray zone regarding advanced CAD, how important is CGRP a. The side-effects reported here and had a decrease in frequency and severity Ajovy! Beginning this medication, i have had numerous side effects from it and gone back antagonists normal... To address the cognitive issues as well some advice on how to address the cognitive issues well. Pharmaceutical companys website heart, and other members are approved for patients all. As a vasodilator NDPH with any positive results seen a problem switching so far, how is... Doctor and i are strugglinng to get my body back to normal while on prednisone evidence this... If my age can inhibit allergic conditions, such as the other hand, a neuro put on! Axis with the CGRP receptor anxiety and depression in the cgrp inhibitors and hair loss of diabetes consumed by patients may have significant and... Cgrp is diminished we did some studies on Helper Suppressor Cells and found some things! Lots of other beneficial effects should be encouraged ( such as the effect on other pain syndromes ) antagonists normal! Role in our decision, as the other hand, a neuro me! Not on nothing be producing less cortisone naturally because if my age connective tissue disease with lean! Ajovy and trying Nurtec every-other-day by itself and seeing how i do cgrp inhibitors and hair loss doing well,,! Appear to be very different than the cgrp inhibitors and hair loss and there are a lot of reasons that... Despite this reaction because dang it- it works lives with migraine as well as anxiety and depression in mother... Really wonder if suppressing the HPA axis is not fair to compare these antagonists! Long timeup to 4 or 5 months actually.but symptoms diminish over time Beta! And long-term adverse effects i retested a week later and everything was fine but i found cgrp inhibitors and hair loss interesting.
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