More than 10% of people worldwide live with migraine disease. If you fall into this category, you know that intense headaches and symptoms like nausea and vomiting can be debilitating. For some people, injectable medications can help decrease migraine occurrence or treat attacks when they start. Could an injection be right for you? Learn more about the types of injectable medications that may provide migraine relief so you can understand what to expect.
Botulinum toxin type A, commonly referred to as Botox, was approved by the Food and Drug Administration (FDA) as a preventative migraine treatment in 2010. Individuals who have migraine headaches more than 15 days per month may be candidates.
Botox is administered in a doctor’s office. Typically, your doctor will use a small needle to deliver multiple injections into areas around your head and neck. The medication is administered into the muscle and may feel like a small pinprick. The process takes about 20 minutes.
Botox blocks nerves near the injected areas from transmitting pain signals. Treatments can reduce the number of headache days by half and may last for about 3 months. It may take two or three treatments to reach full effect, however.
You may experience neck pain or stiffness in the days following the procedure. Occasionally, Botox injected into the forehead can have a temporary cosmetic effect on the movement of your eyelid or brow.
Calcitonin gene-related peptide (CGRP) antagonists are a newer treatment for reducing the frequency and severity of migraine episodes. CGRP is a protein that dilates, or widens, the blood vessels around your brain and causes inflammation of the meninges, the covering of your brain. This plays a role in causing a migraine attack.
CGRP antagonists are a class of drugs that block the action of CGRP. Four injectable medications are currently available for migraine prevention:
- Erenumab (Aimovig): This once-a-month injection is given into the subcutaneous tissue of your body, such as your abdomen, thigh, or upper arm. You or a caregiver will be trained to administer the injection at home using a prefilled syringe or autoinjector, a spring-loaded device.
- Fremanezumab (Ajovy): This subcutaneous injection is available in two dosing schedules, once a month or once every 3 months. It is packaged as a single-use autoinjector to be given at home.
- Galcanezumab (Emgality): This injection comes as a prefilled syringe or autoinjector pen and is self-administered once a month.
- Eptinezumab (Vyepti): This migraine medication is administered in a clinic or doctor’s office via an infusion into your vein. It’s given once every 3 months.
Studies suggest that CGRP antagonists are an effective migraine prevention treatment. Results are often seen within a month. The benefits of eptinezumab may be experienced even quicker since it’s injected directly into your bloodstream.
CGRP antagonists are generally well tolerated. Side effects include injection site reactions and constipation.
Two injectable treatments are also available to help address migraine symptoms after they start:
- Sumatriptan (Imitrex, Sumavel, Zembrace)
- Dihydroergotamine (DHE)
Sumatriptan narrows the blood vessels in the brain and stops pain signals from being transmitted. It comes in a prefilled autoinjector or a vial to be used with a disposable syringe. It’s injected into the subcutaneous tissue. You may receive your first dose in the doctor’s office so that you can be monitored for any reactions. Side effects may include flushing, tingling, or side effects in the chest or throat. If you tolerate sumatriptan well, you may be able to administer your own injections at home.
DHE can act quickly to relieve migraine symptoms, which may be an option if sumatriptan doesn’t work for you. You can be taught to give yourself injections of DHE into your subcutaneous tissue or your muscle. A medical professional can also administer DHE through an intravenous (IV) infusion. Nausea is a potential side effect.
Maintaining good communication with your doctor is important as you are undergoing migraine treatment. Some injectable medications are available in different doses, so that you may need adjustments over time. In addition, most injectable migraine medications are not recommended during pregnancy, and CGRP antagonists should be stopped months before conceiving. Work with your doctor to find the best migraine treatment solution for you.