Migraine headaches are a type of severe headache that can cause relentless pain, sensitivity to light and sound, and nausea.
If you experience frequent migraine attacks, finding an effective treatment can be a challenge. One emerging treatment option are migraine shots, which are also known as injectable medications. In this article, we'll take a closer look at migraine shots, how they work, and whether they're safe.
Understanding CGRP and Its Role in Migraine
To understand how migraine shots work, it's helpful to first understand what the role of CGRP (calcitonin gene-related peptide) plays in migraine. CGRP is a molecule that is involved in the pain signaling process in the brain, and research has shown that it may play a key role in the development of migraine headaches.
Migraine shots work by targeting CGRP, either by blocking its activity or reducing its levels in the body.
Types of Migraine Shots
The drugs we’re about to discuss were developed specifically for migraine. We won’t go into Botox injections, because Botox treatment wasn’t originally intended for migraine (but is sometimes used for that now). This article is about those drugs specifically developed for migraine and those suffering from it.
As far as actual migraine shots go, there are two main types: preventative injectables and injectables for acute treatment.
Injectables for Migraine Prevention
Preventative injectables are designed to be taken on a regular basis to help reduce the frequency, not severity, of migraine attacks so that you can have fewer headache days. There are currently three FDA-approved preventative injectables on the market:
Aimovig (erenumab)
Aimovig is a once-monthly injection that targets the CGRP (calcitonin gene-related peptide) receptor, blocking its activity and reducing the frequency of migraine attacks in adults. Technically, it belongs to a class of drugs called CGRP receptor antagonists. They work by blocking the activity of the CGRP molecule, a key player in the development of migraines.
Aimovig (erenumab) is administered as a monthly injection. It can be given by your healthcare provider, or you can even administer it to yourself using a prefilled auto-injector. It’s designed to reduce migraine frequency in migraineurs who experience at least four migraine days per month.
For that purpose, clinical studies have shown Aimovig effective. In a 5-year study, 77% of patients taking Aimovig experienced at least a 50% reduction in monthly migraine days (MMD) at the last month of assessment. Also, 33% of patients who continued on with the treatment achieved a 100% MMD reduction, and 56% achieved a 75% decrease.
The most common side effects of erenumab are site reactions, constipation, and muscle spasms.
Ajovy (fremanezumab)
Ajovy is also a once-monthly injection that targets CGRP, but instead of blocking the receptor, it binds to the CGRP molecule itself, reducing its levels in the body.
AJOVY (fremanezumab) is administered as a single-dose prefilled syringe or a prefilled pen. One dose can be given every 28 days, and the recommended dosage is 225 mg per month. However, some patients may experience good results from a lower dosage of 225 mg every 3 months.
In clinical trials, AJOVY was shown to be effective in reducing the frequency and severity of migraines. The most common side effects of AJOVY include reactions at the injection site such as pain, redness, or swelling. Other common side effects are constipation, dry mouth, and fatigue.
Emgality (galcanezumab)
Emgality is another once-monthly injection that works by binding to CGRP and preventing it from interacting with its receptor.
Given once every four weeks, this drug is available in a single-dose prefilled syringe or auto-injector. The recommended dosage is 120 mg per month, although some patients may require from a higher initial dose of 240 mg followed by monthly doses of 120 mg.
In a clinical study, Emgality has been shown to help patients with the frequency of chronic migraine attacks. The most common side effects include injection site reactions like pain, redness, or swelling, as well as constipation and diarrhea.
While these medications are usually used for migraine prevention, some CGRP antagonists have been approved for acute treatment.
Injectables for Acute Treatment
Injectables for acute treatment are designed to be taken at the onset of a migraine attack, and they are often used for fast relief. There are currently three FDA-approved injectables for acute migraine treatment:
Sumatriptan (Imitrex)
Imitrex (sumatriptan) belongs to the triptan class of drugs, which help with migraine pain by constricting blood vessels in the brain and reducing inflammation. Sumatriptan is available in injection form and can provide rapid relief for acute migraine attacks. It’s also available in tablet and nasal spray form.
The injection form is typically used for more severe migraine or when medications taken orally have not been effective or well tolerated. Clinical trials have shown that Imitrex can be helpful for pain relief as well as other familiar migraine associated symptoms. Specifically, 60 minutes after a 6 mg dose, 72% of the 422 patients in the study reported a decrease in headache severity.
Dihydroergotamine (DHE)
DHE is an ergot alkaloid that works by constricting blood vessels in the brain. Aside from the injectable form, DHE is also available as an inhaler and a nasal spray. The injection is typically indicated for a more severe migraine where other medications haven’t helped.
A 2019 review of the drug cites a clinical study where 49 of 55 patients became headache-free within 48 hours. Not only that, but 39 patients reported ongoing benefit for up to 16 months.
DHE has a rapid onset and effects lasting up to 48 hours, and is often effective for people when they wake up with a migraine. The most common side effects of DH are nausea and rhinitis (stuffy/runny nose and sneezing).
Lasmiditan (Reyvow)
Lasmiditan is a newer medication that helps with migraine pain by blocking the activity of the 5-HT1F protein, which is involved in migraine development. It’s also available in tablet form. It’s not designed to be a preventative, but is taken as needed when a migraine attack comes on.
A clinical study revealed this drug provided, “significantly more pain freedom” and, “freedom from most bothersome symptom” at 2 hours after administration. The most common side effects were dizziness and sleepiness.
Benefits of Migraine Injections
Migraine injections offer several benefits compared to other forms of migraine treatment.
- Potential reduction in frequency of migraines: Injectable migraine preventatives may help you experience fewer migraine attacks overall.
- Fast-acting relief: Migraine injections can provide rapid symptom relief for acute migraine attacks, even within a few hours.
- Convenience: Many migraine injections can be self-administered at home. If you choose to do it this way, you may find it more convenient than traveling to a doctor's office.
- Long-lasting effects: These migraine injections are typically administered once a month and can provide ongoing protection against migraine attacks, even between doses. Some provide long-lasting active pain relief.
- Fewer side effects: Migraine injections are generally well-tolerated, with few side effects compared to other migraine medications.
Are Migraine Injections Safe?
Like all medications, migraine injections carry some risk of adverse reactions. However, for the most part, these medications are considered safe and well-tolerated. You might expect side effects like pain at the injection site, nausea, and fatigue. Less commonly, people may experience gastrointestinal reactions, allergic reactions, or other more serious adverse reactions.
It's important to note that migraine injections are not suitable for every patient, and this applies to each of the drugs mentioned here. People with some medical conditions or who are taking certain medications may not be able to take a given migraine drug. This may be due to increased risk of interactions (particularly with MAOIs) or serious side effects. It's important to talk to your healthcare provider about whether any migraine injection is safe and appropriate for you.
Alternative Options for Migraine
While migraine injections can be effective for many people, they are not the only option. Maybe you’re being careful about medication overuse or looking for non-pharmaceutical support. Fortunately, there are other choices that may help you pursue fewer headache days.
For example, many people rely on other alternatives like vitamins, minerals, and supplements. Riboflavin, magnesium, CoQ10, and ginger are all worth looking into.
Looking for a tool backed by clinical study? Avulux® Migraine and Light Sensitivity Lenses are the only clinically proven lenses for people with migraine and light sensitivity.
The lenses use patented nano-molecular technology to selectively filter harmful wavelengths and allow soothing ones to pass through. They absorb up to 97% of the most harmful blue, amber, and red light, but at least 70% of the soothing green light will reach your eyes. This helps migraine sufferers manage the impact of light on daily life along with a healthy lifestyle.
Light management may play a key role in managing migraine. In fact, in a 2020 clinical study ad hoc analysis, Avulux lenses showed clinical and statistical significance when compared to placebo in helping people with episodic migraine. Since up to 60% of migraine attacks can be triggered by light alone, it’s important to manage light as part of your migraine management regimen.
Medications, including migraine shots, definitely have their place in helping you manage your condition. But combined with a healthy lifestyle, drug-free alternatives like Avulux lenses can also help you live more comfortably.
