If you live with chronic migraine — meaning you have a headache on 15 or more days per month — you most likely have times when you would try anything to get rid of a migraine headache quickly. Throbbing head pain, sensitivity to lights and sounds, and extreme fatigue can all affect your quality of life, but sometimes over-the-counter medications aren’t quite enough to relieve symptoms.

Migraine injections may help you reduce the frequency of migraine attacks or take the edge off a severe migraine headache. However, not all migraine injections work in the same way, and what works for someone else might not be the right fit for your needs.

Here, we discuss the different types of migraine injections, how they work, and when to consider injections for chronic migraine treatment.

Options for Migraine Injections

Some injectable treatments for migraine aim to prevent or reduce migraine attacks, while others aim to reduce symptoms during an active migraine attack. It’s important to work closely with a headache specialist as you navigate different treatments to manage chronic migraine.

Botox

You might know Botox as a cosmetic wrinkle treatment, but this injection serves other purposes too, such as preventing pain signals from reaching the brain. Its full name as a chronic migraine treatment is onabotulinumtoxin type A, but most people call it by its brand name, Botox.

Botox injections can help prevent migraine attacks if you have 15 or more headache days each month. They may lower how often migraine attacks happen or make them less severe. The effect is not immediate, and it may not be noticeable until you have had several repeat injections over the course of several months. If your doctor recommends this treatment, you’ll get small injections in your head, neck, and shoulders about every 12 weeks.

How It Works

Botox works against migraine attacks by targeting active nerves and blocking their pain signals. More specifically, Botox blocks the release of pain chemicals from the targeted nerves.

The active ingredient in Botox injections is called botulinum toxin type A. It’s a neurotoxin, which means it affects the nerves. It comes from a type of bacteria called Clostridium botulinum that’s found in soil and contaminated food. The toxin can be dangerous in its raw form, but when given by a healthcare professional in a treatment setting, it’s safe.

Possible Side Effects

Botox treatments can cause side effects, so it helps to know what to watch for in case they happen to you. Let your doctor know if you experience any severe pain or discomfort. Other side effects of Botox, which are usually temporary, can include:

• Flu-like symptoms
• Neck pain, stiffness, or discomfort
• Light bruising around the injection sites
• Headache

Botox injections for migraine might affect nerves that control specific muscles. The injections might result in subtle but temporary changes to your appearance, like arched eyebrows or softened wrinkles.

CGRP Inhibitors

Calcitonin gene-related peptide (CGRP) inhibitors, also called anti-CGRP medications, can treat chronic migraine in a couple of ways, depending on how your doctor prescribes them. Some CGRP inhibitors help prevent migraine attacks, and others reduce the intensity of a migraine attack as it’s happening.

Most injectable CGRP inhibitors aim to reduce the number of migraine attacks you get or make them less severe. You self-inject them at home once a month or according to your doctor’s instructions.

How They Work

Injectable CGRP inhibitors target a protein in your body called calcitonin gene-related peptide. This protein helps control blood pressure by widening your blood vessels. When blood vessels widen, blood puts less pressure on their walls.

In many people with migraine, CGRP levels can rise during attacks, and blocking CGRP can help reduce migraine activity. Excessive CGRP in your body can make pain feel more intense and cause it to last longer. CGRP inhibitors prevent this from happening.

Many injectable CGRP inhibitors are monoclonal antibodies that attach to CGRP or its receptor and block CGRP signaling, which can help prevent migraine attacks.

Possible Side Effects

While taking CGRP inhibitors, watch for common side effects and tell your doctor if you have any. CGRP inhibitors can cause a wide range of mild to moderate side effects, including:

• Constipation
• Injection-site reactions, including pain, discoloration, and itching
• Dry mouth
• Nausea
• A tingling or pins-and-needles sensation
• Muscle and joint pain
• Headaches

Emergency Migraine Injections

Emergency migraine injections are treatments you might use during an active migraine headache to reduce symptoms. Sumatriptan, for example, comes in a prefilled auto-injector that you can keep on hand for when you feel a migraine attack starting. In urgent care or emergency settings, doctors may also use other injection-based treatments for severe migraine, such as ketorolac, anti-nausea medicines that also help pain (often dopamine-blocking medicines), or dihydroergotamine (DHE).

Your doctor might want you to use sumatriptan in their office or at a clinic the first time, so a healthcare provider can monitor you. They will also show you how to use the auto-injector on your own.

How They Work

Sumatriptan is a type of drug called a selective serotonin receptor agonist. Sumatriptan and other triptans treat a migraine at the beginning of an attack by narrowing the blood vessels in your brain. They also block pain-causing chemicals in the brain and help reduce nausea. They won’t reduce the number of migraine attacks you get, but they can be helpful during a migraine headache.

Possible Side Effects

Sumatriptan injections can make you sleepy or dizzy, so you shouldn’t drive or operate machinery after an injection. Mild side effects like skin flushing, warmth, and upset stomach may not last long, but you should let your doctor know if they don’t go away. Call your doctor or go to the emergency room if you experience any severe side effects or complications while taking sumatriptan, such as:

• Rash or flushing with numbness or “pins and needles” in the face, arms, legs, or torso
• General malaise (feeling “washed out”)
• Bloody diarrhea
• Chest, neck, or jaw pain or pressure
• Severe stomach pain
• Vomiting
• Pain or burning in your hands or feet
• Shortness of breath

Signs You Should Consider Migraine Injections

You may want to try migraine injections to help prevent migraine attacks or treat them when they happen. Your doctor can help you decide which treatment best fits your needs and preferences. Migraine injections may be an option if you have:

• Frequent migraine attacks — Since some migraine injections can reduce the frequency of migraine attacks, they may be a good option if you have migraine attacks most days in a given month.
• Concerns about medication overuse — Overusing oral medications like nonsteroidal anti-inflammatory drugs (NSAIDs) can put your health at risk. Tell your doctor if you feel like you take oral medications for migraine attacks too often.
• Side effects from oral medications — If side effects from a migraine treatment are too bothersome, your doctor might suggest switching to an injectable treatment.
• Interest in a prevention plan — Preventive treatments like Botox can help you feel more protected since they can reduce the frequency of migraine attacks.

Keep in mind that it may take time to establish a treatment plan to manage chronic migraine. Your doctor might suggest managing symptoms with multiple strategies, including avoiding migraine headache triggers.

Talk to Your Doctor

Let your doctor know if you feel that your migraine treatment plan could be improved. They’ll want to know about any new or worsening symptoms, including medication side effects. They might tell you to keep a headache diary to track migraine headaches and symptoms. Your doctor can help you decide if migraine injections fit into your care plan and teach you more about your different treatment options.

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