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Finding the Right Chronic Migraine Treatment

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How Injections for Chronic Migraine Work

Medically Reviewed By Susan W. Lee, DO

When standard treatments for chronic migraine don’t improve your symptoms, injections may provide long lasting relief and improve your quality of life.

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You can take an over-the-counter pain reliever to soothe a headache, but if you experience migraine episodes, you may wish to consider a different treatment option.

Experts define chronic migraine as experiencing at least 15 headaches per month, 8 of which are migraine episodes. You may take preventive medication with fast-acting treatment to help you manage symptoms.

Some chronic migraine medications come as injections a medical professional can give you or that you can give yourself at home. Here’s what to know before your next doctor’s appointment.

Botulinum toxin for migraine prevention

Some people may associate botulinum toxin with its cosmetic, wrinkle-smoothing effects. However, it also has approval from the Food and Drug Administration (FDA) to treat chronic migraine because it may reduce the number of migraine episodes per month.

Botulinum toxin treatment requires a series of small injections into specific areas around your head and neck. Treatment only takes about 10 minutes in your doctor’s office and can last for 3 months.

Many experts believe the botulinum toxin works by blocking the transmission of pain signals from your nerves to your brain. It doesn’t work immediately and may require a few treatments for you to feel its full effects.

However, your patience may be worth it since a 2020 research review Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source suggested some people may tolerate botulinum toxin better than oral migraine prevention medications.

CGRP inhibitors for migraine prevention

Calcitonin gene-related peptide (CGRP) inhibitors are a newer addition to chronic migraine prevention. CGRP is a protein in your body that occurs at higher levels during a migraine attack. It plays a role in inflammation, pain transmission, and dilation (widening) of your blood vessels. These may all contribute to migraine.

CGRP inhibitors lower the CGRP protein’s activity, which can lead to fewer migraine episodes. Injectable drugs in this class include:

  • erenumab (Aimovig)
  • eptinezumab (Vyepti)
  • fremanezumab (Ajovy)
  • galcanezumab (Emgality)

These medications differ slightly in how you can receive them. Aimovig and Emgality are medications you can inject monthly into the fatty tissue just under your skin, such as your upper arm or abdomen. You can receive Ajovy as a monthly or quarterly injection. Vyepti is an intravenous (IV) infusion you can receive in a doctor’s office every 3 months.

Though all medications may have side effects, some experts consider CGRP inhibitors safe and tolerable for many people.

Benefits of injections for chronic migraine

If you experience frequent migraine attacks, you can talk with your doctor about injectable treatments. Possible advantages include:

  • Improved response to treatment: Typical first-line preventive migraine medications, like beta-blockers, don’t work for everyone. You may find relief with migraine injections.
  • Long intervals between treatments: The effects of injections or infusions can last 1–3 months, which can be helpful if you have difficulty remembering to take medication daily.
  • Better quality of life: If injections reduce the frequency and severity of your migraine episodes, this may improve your ability to participate in your daily activities and the activities you enjoy.

Takeaway

Consult your doctor to determine which type of medication is right for you. When making a selection, considering your medical history, previous migraine treatments, and preferences regarding how you’d like to receive your medication is important.

Injections can be more expensive than conventional migraine prevention treatments. You may wish to contact your insurance company to determine your out-of-pocket expenses for these medications. Some pharmaceutical companies provide patient assistance programs to help offset costs as well.

Keep in mind that preventive migraine injections may significantly decrease the number of migraine episodes you experience each month, but they may not eliminate them entirely.

Talk with your doctor about any concerns or fears related to injections. They can explain the process in detail and make personalized suggestions.

You can still avoid known migraine triggers, prioritize self-care, and utilize fast-acting migraine treatments when a migraine episode occurs. Let your doctor know if your migraine headaches don’t improve so you can make the necessary adjustments to your treatment plan.

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  1. Alasad YW, et al. (2020). Monoclonal antibodies as a preventive therapy for migraine: A meta-analysis. https://www.sciencedirect.com/science/article/abs/pii/S0303846720302432
  2. Siddiqui M, et al. (2021). Comparing the efficacy, safety and superiority of calcitonin gene-related peptide monoclonal antibodies and botox in preventing and treating migraines. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847775/
  3. Weatherall MW. (2015). The diagnosis and treatment of chronic migraine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4416971/

Medical Reviewer: Susan W. Lee, DO
Last Review Date: 2024 Jan 11
View All Finding the Right Chronic Migraine Treatment Articles
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