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Neurologist Compensation: Where Do You Stand?

The FDA has approved Emgality (galcanezumab-gnlm) injection (300 mg) for the treatment of episodic cluster headache in adults, announced the drug’s manufacturer, Eli Lilly and Company, in a 

“Emgality provides patients with the first FDA-approved drug that reduces the frequency of attacks of episodic cluster headache, an extremely painful and often debilitating condition,” said Eric Bastings, MD, Deputy Director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research, in a 

Emgality is the first calcitonin gene-related peptide antibody approved by the FDA for two distinct headache disorders. It was initially approved in 2018 for the preventive treatment of migraine in adults.

After patients receive training from a health care professional, they can administer Emgality at home through subcutaneous injections at the onset of a cluster headache period, and then monthly until the end of a cluster period. The drug is contraindicated in patients with serious hypersensitivity to galcanezumab-gnlm or to any of the excipients.

The effectiveness of Emgality for the treatment of episodic cluster headache was demonstrated in a clinical trial that compared the drug with placebo in 106 patients. The trial measured the average number of cluster headaches per week for 3 weeks and compared the average changes from baseline in the Emgality and placebo groups. During the 3-week period, patients taking Emgality experienced 8.7 fewer weekly cluster headache attacks than they did at baseline, versus 5.2 fewer attacks for patients receiving placebo (

FDA approves Emgality® (galcanezumab-gnlm) as the first and only medication for the treatment of episodic cluster headache that reduces the frequency of attacks

 [press release]. Indianapolis, IN: Eli Lilly and Company; June 4, 2019.

FDA approves first treatment for episodic cluster headache that reduces the frequency of attacks

 [press release]. Silver Spring, MD: US Food and Drug Administration; June 4, 2019.

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Emgality (galcanezumab-gnlm) is the first FDA-approved drug that reduces the frequency of headache attacks.

FDA Gives Nod to New Treatment for Episodic Cluster Headache

Medical cannabis may provide relief of chronic pain, sleep disorders, neuropathy, and anxiety in older adults, according to the results of a 

American Academy of Neurology (AAN) Annual Meeting

Laszlo Mechtler, MD, and colleagues at the 

 conducted a retrospective chart review in patients aged 75 years and older who used cannabis from New York State’s Medical Marijuana Program.

The study included 204 patients (average age, 81 years). For an average of 4 months, the participants received medical cannabis as a liquid extract tincture or capsule or in an electronic vaporizer. The ratios of tetrahydrocannabinol (THC) to cannabidiol (CBD) in the cannabis varied.

Symptomatic benefit was reported by 69% of participants; the most common conditions that improved were chronic pain (49%), sleep problems (18%), neuropathy (15%), and anxiety (10%). Dosages of opioid pain medication were reduced in 32% of patients who received cannabis.

Initially, 34% of participants experienced adverse effects (AEs); after the dosages were adjusted, 13% reported AEs. Somnolence (13%), disequilibrium (7%), and gastrointestinal disturbance (7%) were the most common AEs associated with medical cannabis. Euphoria was reported by 3% of participants. Seven patients (3.4%) discontinued treatment because of AEs. Among those who had no AEs, a balanced THC to CBD tincture (1:1) was the most commonly used formulation.

“Our findings show that medical marijuana is well-tolerated in people age 75 and older and may improve symptoms like chronic pain and anxiety,” said Dr Mechtler in a press statement. “Future research should focus on symptoms like sleepiness and balance problems, as well as efficacy and optimal dosing.”

The study was supported by the Dent Family Foundation.

1. Bargnes V, Paul Hart P, Gupta S, Mechtler L. 

Safety and efficacy of medical cannabis in elderly patients: a retrospective review in a neurological outpatient setting

. Presented at: American Academy of Neurology (AAN) Annual Meeting; May 4-10, 2019; Philadelphia, PA.

Chronic pain, sleep disorders, neuropathy, and anxiety were the most common conditions that showed improvement in the study.

Medical Cannabis May Be Safe, Effective Option for Older Patients

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Neurology Times Staff

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Neurologist Compensation: Where Do You Stand?

FDA Gives Nod to New Treatment for Episodic Cluster Headache

Medical Cannabis May Be Safe, Effective Option for Older Patients

Opinionated Neurologists Wanted