Migraine Shot: Types and Side Effects

There are many treatment options for migraine, including a monthly injectable. Migraine is a type of recurring headache. It can cause intense throbbing or stabbing pain, often on one side of the head.

A migraine can last between four and 72 hours and can involve additional symptoms like nausea, vomiting, vision changes, and sensitivity to light and sound. According to the American Migraine Foundation, approximately 39 million people in the United States suffer from migraines.

Researchers have not yet identified the cause of migraines. Migraine triggers can include stress, anxiety, lack of sleep, certain foods, weather changes, loud noises, flashing lights, etc.

This article will discuss migraine injections, including types and side effects.

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CGRP and Migraine

Calcitonin gene-related peptide (CGRP) is a nervous system molecule that can affect migraine severity. Recent studies indicate that CGRP is released during migraines. It promotes vasodilation (widening of blood vessels), which worsens inflammation and pain.

Once it was discovered that CGRP could both trigger migraines and increase their severity, pharmaceutical companies began to develop ways to block CGRP activity in people with chronic migraines.

Today, there are several migraine preventative injections that block either CGRP or CGRP receptors – the molecules to which CGRP proteins bind on cells – using monoclonal antibodies (laboratory-produced immune system proteins that bind to a specific target).

What is CGRP?

Calcitonin gene-related peptide, or CGRP, is a neuropeptide (a protein produced by neurons) that plays a role in the nervous system’s ability to regulate pain.

Preventive injections

Four prescription injectable medications are available to block CGRP activity: Aimovig, Vypeti, Ajovy, and Emgality. They are all approved by the Food and Drug Administration (FDA) to prevent migraines in adults.

Aimovig

Aimovig (erenumab) was approved by the FDA in 2018 for the preventive treatment of migraines. In clinical trials, monthly self-injection of Aimovig reduced the number of migraine headaches experienced each month.

Unlike other injectable anti-CGRP drugs, Aimovig blocks CGRP receptors rather than binding to CGRP itself.

Ajovy

Ajovy (fremanezumab-vfrm), another anti-CGRP migraine injection, is available in monthly and quarterly options. In clinical trials, Ajovy reduced the number of headache days each month for people with chronic and episodic migraines.

Vyepti

Vyepti (eptinezumab) is a monoclonal antibody that blocks the activity of CGRP to prevent migraines. Unlike other CGRP antagonists, it is an intravenous (IV) drug given by infusion every month. The trials found that Vyepti could reduce the number of headache days in chronic migraine sufferers by eight days per month.

Equality

Emgality (galcanezumab-gnlm) is an anti-CGRP medication, also self-injected monthly, for the prevention of migraine headaches as well as episodic cluster headaches. Episodic cluster headaches are painful and debilitating headaches that usually occur at the same time of day for several weeks or months.

In a clinical trial, people who received an injection of Emgality experienced an average of 8.7 fewer cluster headaches per week.

Side effects

Migraine preventive injections have been shown to be safe and effective in people between the ages of 18 and 65. Most people who take CGRP monoclonal antibodies do not experience side effects. Some people have reported mild to moderate side effects, such as:

  • Redness, swelling or pain at the injection site
  • Constipation
  • Nasal congestion
  • Cramps
  • Muscle spasms

Seek urgent medical help

In rare cases, anti-CGRP drugs can cause an allergic reaction. Seek immediate medical attention if you experience any of the following symptoms after the injection:

  • Swelling of the face, throat, tongue or extremities
  • Difficulty breathing
  • Hives (raised marks) or rash
  • Facial redness

Acute migraine injections

In addition to migraine preventative injections for people with chronic or episodic migraines, two prescription injectable medications, sumatriptan and dihydroergotamine (DHE), have been approved by the FDA for the treatment of acute migraines. You can take them at the start of your migraine to reduce its duration and severity.

Sumatriptan

Sumatriptan is one of the triptans, a class of drugs that treats acute migraines by promoting vasoconstriction (narrowing of blood vessels). They are also serotonin agonists, meaning they bind to serotonin (5-T) receptors in the brain to relieve pain.

Sumatriptan is available as a pill, powder, nasal spray, and injection (Imitrex). Injections may be easier to tolerate if you experience vomiting or nausea in addition to your other migraine symptoms.

Dihydroergotamine

Like sumatriptan, the ergot drug dihydroergotamine (DHE) treats acute migraines by promoting vasoconstriction and inhibiting CGRP activity. It is available in many forms, including self-injection as DHE 45. It works quickly to relieve severe migraines.

Side effects

Common side effects of acute migraine injections can include:

  • Sensations of hot, cold or tingling in the extremities
  • Irritation, redness, swelling or pain at the injection site

In rare cases, people may experience more serious side effects from an acute migraine injection, such as:

  • Chest pain, pressure or tightness
  • Pain, pressure or tightness in the neck, throat or jaw
  • Numbness, dizziness or weakness
  • Swelling
  • Difficulty breathing

If you experience serious adverse side effects from acute migraine injection, seek medical attention immediately.

Other treatment

In addition to injectable CGRP antagonists, there are several other ways to prevent and treat migraines. These may include:

  • Prescription medications, such as triptans or oral steroids
  • Over-the-counter (OTC) medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen
  • Hormone therapy
  • Alternative treatments, such as acupuncture (using thin needles at specific points on the body, which practitioners say direct energy through the body)
  • Neuromodulation devices, which use electrical currents to affect brain activity
  • Identify and avoid migraine triggers, such as certain foods or ingredients
  • Caffeine consumption
  • Application of cold compresses
  • Rest in a cool, dark room
  • get enough sleep
  • Exercise regularly
  • Stress management

Summary

Migraine is a common type of chronic headache that causes throbbing, debilitating pain, along with symptoms like sensitivity to light and sound, vision changes, nausea, and vomiting. Calcitonin gene-related peptide (CGRP), a neuropeptide that causes pain and inflammation when released around the brain, can make migraines worse.

Several prescription injectable medications, including Aimovig, Ajovy, Vyepti, and Emgality, work to prevent migraines by blocking the activity of CGRP. These drugs are given monthly by subcutaneous injection or intravenous (IV) infusion.

There are also two acute migraine injections, sumatriptan and dihydroergotamine, which can provide pain relief during severe migraine attacks.

Other possible treatments for migraine may include prescription and over-the-counter (OTC) medications, as well as lifestyle changes like managing stress, maintaining a better sleep schedule, and exercising regularly. .

A word from Verywell

The pain of migraines can be debilitating and stressful. Speak with your health care provider about a referral to a neurologist or other specialist to discuss treatment with migraine injections.

Frequently Asked Questions

  • How is migraine diagnosed?

    To diagnose you with a migraine, a health care provider will start by asking you about your symptoms and medical history. Other possible conditions can be ruled out with imaging and diagnostic tests, such as computed tomography (CT) or magnetic resonance imaging (MRI).

    Your provider can make a conclusive diagnosis with a physical and neurological exam.

  • How to treat a migraine naturally?

    There are several home remedies and lifestyle changes that can help prevent and treat migraines. Some examples of home remedies include cold compresses, drinking caffeine, and resting in a cool, dark room.

    Ongoing stress management, hydration, healthy sleep habits, regular exercise, and a nutritious diet can also help.

  • What can cause a migraine?

    There is no single cause for migraine. Migraine triggers differ from person to person.

    They can include stress, anxiety, loud noises, bright lights, environmental changes, hormonal changes, certain foods and medications, sleep deprivation, exhaustion from exercise, hunger, smoking and caffeine withdrawal, among others.

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