Understanding Migraine Injections
For individuals whose migraines do not respond well to oral medications, or who need faster relief, injectable treatments can be a game-changer. These shots can be broadly categorized into two types: those used for acute treatment of a migraine attack as it happens, and those used for long-term prevention to reduce the frequency and severity of future migraines. Each type works differently, targeting distinct biological pathways involved in migraine pain.
Acute vs. Preventive Injections
Acute injections, also known as abortive medications, are taken at the first sign of a migraine attack to stop it from progressing. These include triptans and dihydroergotamine, which are designed to provide rapid symptom relief.
Preventive injections are administered on a regular schedule to reduce the overall frequency and intensity of migraines over time. The most common options include CGRP inhibitors and Botox. A comprehensive migraine management plan often incorporates both acute and preventive options, tailored to the individual's specific needs.
Injection Shots for Acute Migraine Attacks
Triptans (e.g., Sumatriptan/Imitrex)
Triptans are a class of medication that works by narrowing blood vessels in the brain and stopping pain signals. Sumatriptan is a commonly prescribed injectable triptan for acute migraines and cluster headaches. It is administered via subcutaneous injection (just under the skin) and can be self-injected at home using an autoinjector or prefilled syringe. Relief can occur within an hour, and a second dose may be used after a waiting period if needed.
Dihydroergotamine (DHE)
This older class of medication works similarly to triptans by constricting blood vessels. DHE is often used for severe, intractable migraines that do not respond to other treatments and has a rapid onset. It is available as a nasal spray and an injection, and some newer autoinjector formulations have recently been approved. Side effects can include nausea and skin rash.
Other In-Office Injections
Some healthcare providers may offer in-office injections for acute relief, such as nerve blocks or other medications. Nerve blocks involve injecting a numbing agent, sometimes with a steroid, near specific nerves in the head or neck to interrupt pain signals and provide rapid relief. Other medications like ketorolac (a potent NSAID) or metoclopramide (an anti-nausea drug) can also be administered via intramuscular injection for severe attacks.
Injection Shots for Migraine Prevention
CGRP Monoclonal Antibodies
This newer class of preventive medications works by targeting the calcitonin gene-related peptide (CGRP) pathway, a protein that plays a key role in causing migraine pain. There are two main types of CGRP monoclonal antibodies: those that block the CGRP receptor and those that bind to the CGRP protein itself.
Erenumab (Aimovig)
Erenumab, sold under the brand name Aimovig, was the first FDA-approved CGRP inhibitor for migraine prevention. It works by blocking the CGRP receptor. Aimovig is self-injected monthly via an autoinjector or prefilled syringe.
Fremanezumab (Ajovy)
Ajovy is another CGRP inhibitor that works by binding to the CGRP protein itself. It can be self-administered monthly or as three injections once every three months, offering flexible dosing options.
Galcanezumab (Emgality)
Emgality also binds to the CGRP protein to block its action. It is self-injected once a month and is approved for both migraine prevention and cluster headache treatment.
Eptinezumab (Vyepti)
Vyepti is unique among injectable CGRP inhibitors as it is administered via a quarterly intravenous (IV) infusion in a clinical setting. This can be a benefit for those who prefer not to self-inject.
Botox (OnabotulinumtoxinA)
Botox is a series of injections approved for the prevention of chronic migraines, defined as 15 or more headache days per month. A healthcare provider administers approximately 31 injections into specific areas of the head, face, and neck muscles. Treatment is repeated every 12 weeks, and the effects build over time.
Comparing Migraine Injection Options
| Feature | Triptans (e.g., Sumatriptan) | CGRP Monoclonal Antibodies (e.g., Aimovig, Ajovy, Emgality) | Botox (onabotulinumtoxinA) |
|---|---|---|---|
| Purpose | Acute treatment of an active attack | Preventive treatment to reduce frequency | Preventive treatment for chronic migraines |
| Mechanism | Constricts blood vessels and blocks pain signals | Blocks CGRP protein or its receptor | Blocks release of pain-related neurotransmitters |
| Administration | Subcutaneous self-injection or clinic setting | Subcutaneous self-injection (monthly or quarterly) or quarterly IV infusion (Vyepti) | Intramuscular injections by a professional |
| Frequency | As needed during an attack (up to a max dose) | Monthly or quarterly | Every 12 weeks |
| Onset of Effect | Rapid, within an hour or less | Gradual, with noticeable effects in 1-2 months | Gradual, building over 2-3 treatment cycles |
How to Administer Migraine Injections
Most injectable migraine medications for home use, such as triptans and CGRP inhibitors, come in user-friendly prefilled syringes or autoinjectors. Patients are trained by their doctor or pharmacist on how to properly perform a subcutaneous injection into the thigh, abdomen, or upper arm. Vyepti, however, requires an IV infusion administered in a healthcare setting by a professional. Botox injections are also exclusively administered by a qualified healthcare professional.
Potential Side Effects and Considerations
While generally well-tolerated, all injections have potential side effects. Common issues with self-injected CGRP inhibitors and triptans often involve the injection site, causing pain, redness, or swelling. Other possible effects vary by medication:
- Triptans can cause flushing, tingling, drowsiness, or feelings of tightness in the chest, neck, or jaw. They are not recommended for people with a history of heart or vascular disease.
- CGRP Inhibitors (e.g., Aimovig) can cause constipation and, in rare cases, high blood pressure.
- Botox injections can sometimes cause neck pain, headache, or temporary drooping of an eyelid.
It is crucial to discuss any existing medical conditions and all medications with a healthcare provider before starting a new injectable treatment.
Conclusion
Injection shots for migraines represent a powerful and effective treatment option for many individuals, particularly those with frequent, severe, or difficult-to-treat migraines. Options range from fast-acting acute treatments like triptans to long-term preventive strategies like CGRP inhibitors and Botox. The decision on which injectable therapy is most suitable depends on the type of migraine experienced, a patient's overall health profile, and specific treatment goals. Consulting with a neurologist or headache specialist is the best approach to determining a personalized and effective treatment plan. For further information and support, the American Migraine Foundation offers extensive resources for patients and caregivers.
