A migraine headache may 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, around 39 million people in the U.S. experience migraines.
Researchers have not yet identified the cause of migraines. Migraine triggers may include stress, anxiety, lack of sleep, certain foods, changes in the weather, loud noises, flashing lights, and more.
This article will discuss migraine injections, including types and side effects.
CGRP and Migraine
Calcitonin gene-related peptide (CGRP) is a molecule in the nervous system that may affect migraine severity. Recent studies indicate that CGRP is released during migraines. It promotes vasodilation (widening of the 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.
Now, there are several different preventative migraine 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).
Preventative Injections
Four injectable prescription 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 preventative treatment of migraines. In clinical trials, a once-monthly self-injection of Aimovig reduced the number of migraines people experienced each month.
Unlike other injectable anti-CGRP medications, Aimovig blocks CGRP receptors rather than binding onto CGRP itself.
Ajovy
Ajovy (fremanezumab-vfrm), another anti-CGRP migraine injection, is available in both every-month and every-three-month options. In clinical trials, Ajovy reduced the number of headache days each month for people with both chronic and episodic migraines.
Vyepti
Vyepti (eptinezumab) is a monoclonal antibody that blocks CGRP activity to prevent migraines. Unlike other CGRP antagonists, it’s an intravenous (IV) medication delivered via infusion each month. Trials revealed that Vyepti could reduce the number of headache days in people with chronic migraine by eight days per month.
Emgality
Emgality (galcanezumab-gnlm) is an anti-CGRP medication, also self-injected monthly, for the prevention of migraines as well as episodic cluster headaches. Episodic cluster headaches are painful, debilitating headaches that usually occur at the same time of day across several weeks or months.
In a clinical trial, people who were injected with Emgality experienced 8.7 fewer cluster headaches per week on average.
Side Effects
Preventative migraine injections have been found to be safe and effective in people between the ages of 18 and 65. Most people who take CGRP monoclonal antibodies don’t experience side effects. Some people reported mild to moderate side effects, such as:
Redness, swelling, or pain at the site of injection Constipation Nasal congestion Cramps Muscle spasms
Acute Migraine Injections
In addition to preventative migraine injections for people with chronic or episodic migraines, two prescribed injectable drugs—sumatriptan and dihydroergotamine (DHE)—have been FDA-approved for the treatment of acute migraines. You can take them at the onset of your migraine to lessen its length and severity.
Swelling in the face, throat, tongue, or extremitiesDifficulty breathingHives (raised welts) or rashFacial flushing
Sumatriptan
Sumatriptan is one of the triptans, a class of drugs that treats acute migraine headaches by promoting vasoconstriction (narrowing of the blood vessels). They are also serotonin agonists, which means 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). The injections may be easier to tolerate if you experience vomiting or nausea alongside your other migraine symptoms.
Dihydroergotamine
Like sumatriptan, the ergot medication dihydroergotamine (DHE) treats acute migraines by promoting vasoconstriction and inhibiting CGRP activity. It’s available in many forms, including via self-injection as DHE 45. It acts quickly to relieve severe migraine headache pain.
Side Effects
Common side effects of acute migraine injections may include:
Hot, cold, or prickly sensations in the extremitiesIrritation, redness, swelling, or pain at the injection site
In rare cases, people may experience more severe side effects from an acute migraine injection, such as:
Chest pain, pressure, or tightnessPain, pressure, or tightness in the neck, throat, or jawNumbness, dizziness, or weaknessSwellingDifficulty breathing
If you experience serious adverse side effects from an acute migraine injection, seek medical help immediately.
Other Treatment
In addition to injectable CGRP antagonists, there are several other ways to prevent and treat migraine headaches. These may include:
Prescription medications, such as triptans or oral steroids Over-the-counter (OTC) medications, such as non-steroidal anti-inflammatories (NSAIDs) and acetaminophen Hormonal therapy Alternative treatments, such as acupuncture (using thin needles at specific points on the body, which is believed by practitioners to direct energy in the body) Neuromodulation devices, which use electrical currents to affect brain activity Identifying and avoiding migraine triggers, such as certain foods or ingredients Caffeine consumption Applying cold packs Resting in a cool, dark room Getting enough sleep Exercising regularly Stress management
Summary
Migraine is a common type of chronic headache that causes debilitating, throbbing pain, as well as symptoms like light and sound sensitivity, 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 injectable prescription drugs including Aimovig, Ajovy, Vyepti, and Emgality work to prevent migraines by blocking CGRP activity. These medications are delivered monthly via subcutaneous injection or intravenous (IV) infusion.
There are also two acute migraine injections—sumatriptan and dihydroergotamine—that can relieve pain during severe migraine attacks.
Other possible treatments for migraine may include prescription and over-the-counter (OTC) medications, as well as lifestyle changes like stress management, maintaining a better sleep schedule, and getting regular exercise.
A Word From Verywell
The pain from migraine headaches can be debilitating and stressful. Talk to your healthcare provider about a referral to a neurologist or another specialist to discuss treatment with migraine injections.
Your provider can make a conclusive diagnosis with a physical and neurological exam.
Ongoing stress management, hydration, healthy sleep habits, regular exercise, and a nutritious diet can also help.
They may include stress, anxiety, loud noises, bright lights, environmental changes, hormonal changes, certain foods and medications, sleep deprivation, exhaustion from exercise, hunger, tobacco use, and caffeine withdrawal, among others.
