If you're someone who has both MCAS and migraines I advise serious caution with this medication. While it made a significant impact on my migraines i can't say that I think this medication was overall good for me. It gave me the worst MCAS flare of my life after I did the standard 240mg loading dose. I had to go to the hospital for my reaction: incl heart palpitations, chest pain, nerve pain radiating to behind the left breast, stomach cramping, nausea and constipation and diarrhea at the same time. Since then, I have lost the ability to tolerate and eat even more foods than beore I did the injection, and can no longer tolerate Nurtec as it's in the same class of medication and brings my post injection symptoms back. I should also note that my period and menstrual cycle has never been the same post Emgality. it has caused me to have perpetual nerve pain in my left arm that radiates to behind my left breast the week before my period, I have had severe PMDD exacerbation that gives me anhedonia and then a huge anxiety spike the week before menstruation, and then I feel normal when menstruating, only for it to restart again. I have also lost significant amount of hair from this medicine and I have had mysterious "kidney pain" symptoms where I did the injection for months now. I think this a very effective drug for the people it works for - as a lifelong migraine sufferer - it did help there. but the MCAS reaction and side effects have not been worth it for me to ever inject myself again.

I started on the recommended dose of Emgality, 240mg loading dose and then 120mg / month thereafter. This did NOT work. My migraines would improve significantly for about 7-10 days, and then they would come back worse than before for the rest of the month. It seemed to me that the dose wasn’t high enough and was wearing off too quickly. My neurologist agreed to allow me to take 240mg every two weeks, 4 times the approved dose. Since then it’s been amazing. Almost no migraines since we switched to this protocol. This is uncharted territory, as post-COVID migraines are not understood and there are no clinical trials testing these mAbs on post-COVID patients. But at least for my case, I needed a way higher dose than other people with migraines do.