Table of ContentsView AllTable of ContentsCGRP and MigrainePreventative InjectionsAcute Migraine InjectionsOther Treatments
Table of ContentsView All
View All
Table of Contents
CGRP and Migraine
Preventative Injections
Acute Migraine Injections
Other Treatments
Migraineprevention injection is one of many treatment options for migraine, a type of recurring headache.Migraine headachesmay cause intense pulsing or throbbing pain, often on one side of the head.Four injectable prescription medications are available to prevent migraines in adults: Aimovig, Vyepti, Ajovy, and Emgality.
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 United States experience migraines.
Researchers have not yet identified the cause of migraines.Migraine triggersmay include stress, anxiety, lack of sleep, certain foods, changes in the weather, loud noises, flashing lights, and more.Aside from preventative injections, acute migraine injections and lifestyle behaviors may also help you manage these chronic headaches.
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Research studies indicate that CGRP is released during migraines. It promotesvasodilation(widening of the blood vessels), which worsens inflammation and pain.
Scientists discovered that CGRP could both trigger migraines and increase their severity. Armed with this knowledge, pharmaceutical companies began to develop ways to block CGRP activity in people withchronic migraines.
Now, there are several differentpreventative migraine injectionsthat block either CGRP or CGRP receptors. The receptors are the molecules to which CGRP proteins bind on cells. The injections consist ofmonoclonal antibodies(laboratory-produced immune system proteins that bind to a specific target).
How Is Migraine Diagnosed?
Your provider can make a conclusive diagnosis with a physical and neurological exam.
Aimovig
Unlike other injectable anti-CGRP medications, Aimovig blocks CGRP receptors rather than binding onto CGRP itself.
Aimovig is currently used for adults dealing with occasional (episodic) or chronic migraines. It may take effect within the first month of use but can take two to three months of treatment to feel significant improvements. Aimovig should be taken once per month to maintain effectiveness.
Ajovy
Ajovy (fremanezumab-vfrm) is another anti-CGRP migraine injection for migraine prevention. Ajovy is given as an injection underneath the skin (subcutaneous) once a month or once every three months.
In clinical trials, Ajovy reduced the number of headache days each month for people with both chronic and episodic migraines.Many people notice improvement within one month of taking Ajovy, but it can take several months to see the drug’s full effect.The length of effectiveness will be one month, or up to three months, depending on which injection dosage you choose.
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 over approximately 30 minutes every three months.
Emgality
Emgality(galcanezumab-gnlm) is an anti-CGRP medication, also self-injected monthly. It is for the prevention of migraines as well as episodiccluster 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.
Injection doses may differ depending on whether Emgality is being used for cluster headaches or migraines. Emgality begins reducing the days of migraine headaches on the first day after the first injection and helps for about one month before another injection is needed.
Side Effects of Preventative Injections
Preventative migraine injections have been found to be safe and effective in people between the ages of 18 and 65 years.Most people who take CGRP monoclonal antibodies don’t experience side effects, but some people reported mild to moderate side effects, such as:
Seek Urgent Medical HelpIn rare cases, anti-CGRP medications could cause an allergic reaction.Seek immediate medical help if you have any of the following symptoms after injection:Swelling in the face, throat, tongue, or extremitiesDifficulty breathingHives (raised welts) or rashFacial flushing
Seek Urgent Medical Help
In rare cases, anti-CGRP medications could cause an allergic reaction.Seek immediate medical help if you have any of the following symptoms after injection:Swelling in the face, throat, tongue, or extremitiesDifficulty breathingHives (raised welts) or rashFacial flushing
In rare cases, anti-CGRP medications could cause an allergic reaction.Seek immediate medical help if you have any of the following symptoms after injection:
Sumatriptan
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.
Sumatriptan is usually recommended for people who have four or fewer migraines per month.It should be taken at the first sign of a migraine. The tablets begin working within 30 to 60 minutes, while the nasal spray and injection begin working even faster.Sometimes a second dose of the tablets is needed if the migraine returns within one to two hours.
Dihydroergotamine
How quickly the nasal spray works will vary depending on how fast your body absorbs the medication. The injection is effective and consistent because almost 100% of the medication gets into the bloodstream. IV infusion is the fastest, most effective method and is often used to treat migraines that have lasted more than 72 hours.
Side Effects of Acute Migraine Injections
Common side effects of acute migraine injections may include:
In rare cases, people may experience more severeside effectsfrom an acute migraine injection, such as:
If you experience serious adverse side effects from an acute migraine injection, seek medical help immediately.
What Causes Migraine?There is no singlecause of migraine. Migraine triggers differ from person to person.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.
What Causes Migraine?
There is no singlecause of migraine. Migraine triggers differ from person to person.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.
There is no singlecause of migraine. Migraine triggers differ from person to person.
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.
In addition to injectable CGRP antagonists, there are several other ways to prevent andtreat migraine headaches.These may include:
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. Talk to your healthcare provider about a referral to a neurologist or another specialist to discuss treatment with migraine injections.
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 managing stress, maintaining a healthy sleep schedule, and getting regular exercise.
19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Migraine.National Institute of Neurological Disorders and Stroke.Migraine.American Migraine Foundation.What is migraine?Mohanty D, Lippmann S.CGRP inhibitors for migraine.Innov Clin Neurosci. 2020;17(4-6):39-40.American Migraine Foundation.What to know about the new anti CGRP migraine treatment options.U.S. Food and Drug Administration.FDA approves novel preventive treatment for migraine.Andreou AP, Fuccaro M, Lambru G.The role of erenumab in the treatment of migraine.Ther Adv Neurol Disord. 2020;13:1756286420927119. doi:10.1177/1756286420927119U.S. Food and Drug Administration.Drug trials snapshot: Ajovy.Gao B, Sun N, Yang Y, et al.Safety and efficacy of fremanezumab for the prevention of migraine: a meta-analysis from randomized controlled trials.Front Neurol.2020;11:435. doi:10.3389/fneur.2020.00435U.S. Food and Drug Administration.Drug trials snapshots: Vyepti.Silberstein S, Diamon M, Hindiyeh NA.Eptinezumab for the prevention of chronic migraine: efficacy and safety through 24 weeks of treatment in the phase 3 PROMISE-2 (prevention of migraine via intravenous ALD403 safety and efficacy-2) study.J Headache Pain. 2020;21(1):120. doi:10.1186/s10194-020-01186-3Food and Drug Administration.FDA approves first treatment for episodic cluster headache that reduces the frequency of attacks.Monteith D, Collins EC, Vandermeulen C, et al.Safety, tolerability, pharmacokinetics, and pharmacodynamics of the CGRP binding monoclonal antibody LY2951742 (galcanezumab) in healthy volunteers.Front Pharmacol.2017;8:740. doi:10.3389/fphar.2017.00740MedlinePlus.Sumatriptan.National Health System UK.About sumatriptan.American Migraine Foundation.Dihydroergotamine (DHE) for migraine treatment.American Academy of Neurology.AAN patient and provider shared decision-making tool | migraine.American Migraine Foundation.Neuromodulation for migraine treatment: an overview.Harvard Health Publishing.If you have migraines, put down your coffee and read this.
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Migraine.National Institute of Neurological Disorders and Stroke.Migraine.American Migraine Foundation.What is migraine?Mohanty D, Lippmann S.CGRP inhibitors for migraine.Innov Clin Neurosci. 2020;17(4-6):39-40.American Migraine Foundation.What to know about the new anti CGRP migraine treatment options.U.S. Food and Drug Administration.FDA approves novel preventive treatment for migraine.Andreou AP, Fuccaro M, Lambru G.The role of erenumab in the treatment of migraine.Ther Adv Neurol Disord. 2020;13:1756286420927119. doi:10.1177/1756286420927119U.S. Food and Drug Administration.Drug trials snapshot: Ajovy.Gao B, Sun N, Yang Y, et al.Safety and efficacy of fremanezumab for the prevention of migraine: a meta-analysis from randomized controlled trials.Front Neurol.2020;11:435. doi:10.3389/fneur.2020.00435U.S. Food and Drug Administration.Drug trials snapshots: Vyepti.Silberstein S, Diamon M, Hindiyeh NA.Eptinezumab for the prevention of chronic migraine: efficacy and safety through 24 weeks of treatment in the phase 3 PROMISE-2 (prevention of migraine via intravenous ALD403 safety and efficacy-2) study.J Headache Pain. 2020;21(1):120. doi:10.1186/s10194-020-01186-3Food and Drug Administration.FDA approves first treatment for episodic cluster headache that reduces the frequency of attacks.Monteith D, Collins EC, Vandermeulen C, et al.Safety, tolerability, pharmacokinetics, and pharmacodynamics of the CGRP binding monoclonal antibody LY2951742 (galcanezumab) in healthy volunteers.Front Pharmacol.2017;8:740. doi:10.3389/fphar.2017.00740MedlinePlus.Sumatriptan.National Health System UK.About sumatriptan.American Migraine Foundation.Dihydroergotamine (DHE) for migraine treatment.American Academy of Neurology.AAN patient and provider shared decision-making tool | migraine.American Migraine Foundation.Neuromodulation for migraine treatment: an overview.Harvard Health Publishing.If you have migraines, put down your coffee and read this.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
MedlinePlus.Migraine.National Institute of Neurological Disorders and Stroke.Migraine.American Migraine Foundation.What is migraine?Mohanty D, Lippmann S.CGRP inhibitors for migraine.Innov Clin Neurosci. 2020;17(4-6):39-40.American Migraine Foundation.What to know about the new anti CGRP migraine treatment options.U.S. Food and Drug Administration.FDA approves novel preventive treatment for migraine.Andreou AP, Fuccaro M, Lambru G.The role of erenumab in the treatment of migraine.Ther Adv Neurol Disord. 2020;13:1756286420927119. doi:10.1177/1756286420927119U.S. Food and Drug Administration.Drug trials snapshot: Ajovy.Gao B, Sun N, Yang Y, et al.Safety and efficacy of fremanezumab for the prevention of migraine: a meta-analysis from randomized controlled trials.Front Neurol.2020;11:435. doi:10.3389/fneur.2020.00435U.S. Food and Drug Administration.Drug trials snapshots: Vyepti.Silberstein S, Diamon M, Hindiyeh NA.Eptinezumab for the prevention of chronic migraine: efficacy and safety through 24 weeks of treatment in the phase 3 PROMISE-2 (prevention of migraine via intravenous ALD403 safety and efficacy-2) study.J Headache Pain. 2020;21(1):120. doi:10.1186/s10194-020-01186-3Food and Drug Administration.FDA approves first treatment for episodic cluster headache that reduces the frequency of attacks.Monteith D, Collins EC, Vandermeulen C, et al.Safety, tolerability, pharmacokinetics, and pharmacodynamics of the CGRP binding monoclonal antibody LY2951742 (galcanezumab) in healthy volunteers.Front Pharmacol.2017;8:740. doi:10.3389/fphar.2017.00740MedlinePlus.Sumatriptan.National Health System UK.About sumatriptan.American Migraine Foundation.Dihydroergotamine (DHE) for migraine treatment.American Academy of Neurology.AAN patient and provider shared decision-making tool | migraine.American Migraine Foundation.Neuromodulation for migraine treatment: an overview.Harvard Health Publishing.If you have migraines, put down your coffee and read this.
MedlinePlus.Migraine.
National Institute of Neurological Disorders and Stroke.Migraine.
American Migraine Foundation.What is migraine?
Mohanty D, Lippmann S.CGRP inhibitors for migraine.Innov Clin Neurosci. 2020;17(4-6):39-40.
American Migraine Foundation.What to know about the new anti CGRP migraine treatment options.
U.S. Food and Drug Administration.FDA approves novel preventive treatment for migraine.
Andreou AP, Fuccaro M, Lambru G.The role of erenumab in the treatment of migraine.Ther Adv Neurol Disord. 2020;13:1756286420927119. doi:10.1177/1756286420927119
U.S. Food and Drug Administration.Drug trials snapshot: Ajovy.
Gao B, Sun N, Yang Y, et al.Safety and efficacy of fremanezumab for the prevention of migraine: a meta-analysis from randomized controlled trials.Front Neurol.2020;11:435. doi:10.3389/fneur.2020.00435
U.S. Food and Drug Administration.Drug trials snapshots: Vyepti.
Silberstein S, Diamon M, Hindiyeh NA.Eptinezumab for the prevention of chronic migraine: efficacy and safety through 24 weeks of treatment in the phase 3 PROMISE-2 (prevention of migraine via intravenous ALD403 safety and efficacy-2) study.J Headache Pain. 2020;21(1):120. doi:10.1186/s10194-020-01186-3
Food and Drug Administration.FDA approves first treatment for episodic cluster headache that reduces the frequency of attacks.
Monteith D, Collins EC, Vandermeulen C, et al.Safety, tolerability, pharmacokinetics, and pharmacodynamics of the CGRP binding monoclonal antibody LY2951742 (galcanezumab) in healthy volunteers.Front Pharmacol.2017;8:740. doi:10.3389/fphar.2017.00740
MedlinePlus.Sumatriptan.
National Health System UK.About sumatriptan.
American Migraine Foundation.Dihydroergotamine (DHE) for migraine treatment.
American Academy of Neurology.AAN patient and provider shared decision-making tool | migraine.
American Migraine Foundation.Neuromodulation for migraine treatment: an overview.
Harvard Health Publishing.If you have migraines, put down your coffee and read this.
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