Migraine Auto-Injector Pens: Cost, Types, etc.

Migraine is a neurological condition that causes moderate to severe headaches. A migraine self-injection pen is a device that allows a person to self-administer migraine medication to the tissues under the skin.

Migraine is common, affecting 39 million people in the United States and 1 billion people worldwide.

The pens can be either a preventative treatment, containing medicines to reduce the frequency and severity of migraine attacks, or an acute treatment containing medicines to help relieve migraines that have already started. Some pens only require the click of a button.

A 2014 study on injection pens containing non-migraine medications has shown the devices to be safe and easy to use. In addition, a 2018 study reported that many people prefer autoinjector pens to pre-filled syringes. Overall, participants found the pens to cause less discomfort.

This article describes what migraine auto-injector pens are, the different types, their associated mechanisms of action, side effects, and costs.

Migraine auto-injector pens contain one of three types of medications:

Triptans

The triptans are First line drugs that help relieve acute migraines. They work in two ways: by blocking the transmission of pain signals to the brain and by narrowing the blood vessels which tend to dilate during a migraine attack. Triptans do this by stimulating specific serotonin receptors found on muscle cells in blood vessels.

An example of an injectable triptan is sumatriptan, also available under the brand names Imitrex and Zembrace.

Dihydroergotamine mesylate

Dihydroergotamine mesylate (DHE 45) is another option for relieving acute migraines. This drug works by constricting the dilated blood vessels in the brain, acting on serotonin receptors in the same way as triptans.

Monoclonal peptide antibodies linked to the calcitonin gene

Calcitonin gene-linked peptide (CGRP) monoclonal antibodies are drugs that help prevent migraine. They target the substance CGRP, which the brain releases during a migraine attack.

Examples of CGRP monoclonal antibodies are:

The following section contains instructions on using the different types of migraine pens, including dosages and frequency of administration.

Imitrex

Imitrex is a type of triptan. A person should take the medicine at the first sign of a migraine attack. However, people should not take it during the aura phase of a migraine, which some people experience before the onset of a migraine.

A person can take a second dose, but they should wait at least 1 hour after giving the first.

The maximum single dose of sumatriptan is 6 milligrams (mg). People should not exceed 12 mg within 24 hours.

Here are the instructions for use:

  1. Twist and remove the safety cap.
  2. Place the needle guard over the injection site at a 90 degree angle. One possible injection site is the thigh.
  3. Firmly push the autoinjector as far as it will go.
  4. While holding the autoinjector, press the blue button until a click is heard and hold it for 5 seconds.
  5. Gently remove the autoinjector from the skin.

DHE 45

An injection of DHE 45 may help relieve symptoms after the onset of an acute migraine. A doctor will prescribe the recommended dosage on a case-by-case basis.

A person should not give a second dose within 6 hours of the first. In addition, they should not use the drug every day or exceed a dose of 6 milliliters (ml) in a week.

The injection site should be the thigh, well above the knee. A person should ask for instructions before self-administering the first dose, as the procedure is not as simple as using other injection pens.

Emgality

Equality is a type of CGRP monoclonal antibody that works to reduce the frequency and severity of migraine attacks.

The manufacturer recommends two consecutive doses of 120 mg as the starting dose or “loading dose”. Then the dose is a single injection of 120 mg once a month.

When administering Emgality, a person can choose from the following injection sites:

  • the back of the arm
  • abdomen
  • buttocks
  • thighs

Here are the instructions for use:

  1. Unscrew the cap and hold the base against the skin.
  2. Turn the locking ring to the unlocked position.
  3. Press and hold the turquoise injection button until a second click is heard, approximately 10 seconds after the first click.
  4. Remove the injection pen from the skin.

Acute treatments aimed at reducing the effects of a migraine attack have a shorter duration of action than preventive treatments.

Imitrex relieves an acute migraine attack and its effects last for 1 day.

An injection of DHE 45 usually prevents migraines from returning within 24 hours.

Emgality is a preventative medication that a person takes once a month, suggesting that the effects last for 1 month.

Most insurance companies will cover the cost of a migraine auto-injector pen on the recommendation of a doctor.

The retail prices for the different types of migraine auto-injector pens are as follows:

  • Imitrex: A dose of 1 ml costs $ 438.
  • DHE 45: A 10 ml container costs $ 12,295, or $ 1,229 per unit.
  • Emgality: A 120 ml dose costs $ 665.

Generic versions of Imitrex and DHE 45 are available at lower cost. However, a generic version of Emgality is not yet available.

Below are the most serious risks and side effects of migraine auto-injector pens.

Imitrex

Common side effects of Imitrex include:

Imitrex can also trigger serious cardiovascular events, such as a heart attack and stroke. As such, the drug is not suitable for people with the following conditions:

Learn more about the side effects of Imitrex here.

DHE 45

The potential side effects of DHE 45 include:

DHE 45 can cause cardiovascular events, such as heart attacks and cardiac arrhythmias. Although rare, some of these incidents have been fatal.

The drug can also cause the arteries in the heart and other parts of the body to spasm. These spasms can interrupt blood flow.

Due to the above risks, DHE 45 is not suitable for people with pre-existing cardiovascular disease or those with risk factors for such conditions. These risk factors can include:

Emgality

Equality can cause angioedema, which swells under the skin.

In some cases, the drug can cause hypersensitivity or an allergic reaction. The medical literature also reports cases of a serious and life-threatening allergic reaction known as anaphylaxis.

Possible signs and symptoms of anaphylaxis include:

Learn more about the side effects of Emgality here.

Migraine auto-injector pens are devices that a person can use to administer migraine medication. Some pens contain CGRP monoclonal antibodies to help reduce the frequency and severity of migraine attacks. Others contain drugs such as triptans or DHE 45 to help relieve the symptoms of an acute migraine attack that has already started.

Evidence shows that migraine auto-injector pens are both safe and easy to use. However, some injection pens can cause serious cardiovascular side effects. This makes them unsuitable for people with pre-existing cardiovascular problems and those at increased risk of developing them.

A person who is considering using an auto-injector pen for migraine may speak with a doctor about the various options available.


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