Migraine Injection Pens: Do They Work?

Migraine is the most common neurological disease in the world. In the United States, about 39 million¹ individuals battle this condition. When migraine headaches strike, they bring pain, disorientation, nausea, and many other debilitating symptoms. Managing them can be challenging.

One of the ways to prevent these attacks or reduce the symptoms is to take medication. Some of the recommended drugs work better when injected. While it's possible to get an injection in the emergency department or the doctor's office, it requires time.

An alternative to a medical visit is an at-home solution — a migraine injection pen. Let's take a closer look at what it is and how it works.

What are migraine self-injection pens?

An injection pen is a device you can use to inject medication under your skin. Once your doctor prescribes it, you can use a self-injector pen at home without their direct supervision. Migraine injection pens are easy to use. However, you need a medical professional's instructions before using them for the first time.

Migraine self-injection pens can contain two types of migraine medication:

Preventive medication

This can be used to prevent migraine attacks. A doctor will explain how often you should give yourself injections and how to store the drugs to ensure their effectiveness.

Acute medication

This type of medication can alleviate some of the symptoms once your migraine attack begins. A doctor will explain when and how to administer it depending on the stage of the attack.

Self-injection pens provide migraine patients with a unique opportunity to prevent or alleviate their symptoms without leaving the house. Since a migraine can make any movement unbearable, going to the emergency department or medical office often becomes challenging.

How do self-injection pens work?

Injection pens deliver drugs subcutaneously (under your skin). They are prefilled with medication that is released through a spring system.

Over 20 pharmaceutical companies have developed around 80 auto-injecting pens for various medical needs. Around 62% of these pens are disposable. This means you can't refill the pen once the medication is gone. However, with environmental concerns in mind, companies are working to increase the number of reusable pens.

You can find pens that:

• Can be used with just one hand

• Have a twist-and-mix mechanism (for mixing drugs and dilutants)

• Feature a sleek design

• Have a Bluetooth connection

While it's possible to administer migraine medication with a regular syringe, people often feel anxiety and fear about using them.

Benefits of a self-injection migraine pen 

The key benefits of using self-injection pens instead of syringes with needles are:

Simple administration

Traditional syringe injections involve more steps than the injector pen option. Those who choose migraine self-injection pens can carry them around easily, use them anytime and anywhere (as needed), and don't need medical supervision.

When a migraine strikes, many people experience vision and concentration problems. While struggling with these symptoms, preparing a syringe can be complicated or even dangerous. Since self-injection pens are pre-loaded with medication, you don't need to worry about drawing up the medication or mixing it with dilutants.

Reduced anxiety

Fear of needles is a common problem among children and adults. According to a small study² of patients visiting a medical practice, 22% reported a fear of needles. Many of these patients try to avoid medical treatment in order not to face a shot. For some, the anxiety from seeing a needle is much worse than the pain caused by the shot itself.

When using a self-injection pen, you don't need to look at a needle or physically insert it into your skin. All you have to do is position the pen, press a button, and the device does the rest for you. This reduces any anxiety associated with giving yourself a shot.

Easy to use

Self-injection pens³ are widely used to deliver drugs that help with various conditions, including diabetes, rheumatoid arthritis, multiple sclerosis, and psoriasis. One of the reasons they are so popular is a low learning curve.

Many patients find self-injector pens easy to use. One study⁴ demonstrated that the success rate for participants injecting medication with the pen was 94% for the first injection and 100% for the second injection. The majority reported that they felt confident about using the pen. The researchers concluded that people who receive minimal instructions for using a self-injection pen could administer medication safely and effectively without additional training.

Proper administration

Using a migraine self-injection pen automatically delivers the right amount of medication at the appropriate depth under your skin. You don't have to worry about administering too much or too little, spilling anything in the process, or sticking the needle too far into the skin. 

Drug delivery through the injection pen is more regulated and consistent than manual injections. Having more control of the process gives the user a mental advantage.

Smart self-injection pens that connect to your smartphone or other devices can register your doses and prevent you from missing a dose.

Using self-injection pens makes it easy for patients with migraine headaches to manage their condition. Having an autoinjector at your disposal can reduce the anxiety of facing an unexpected migraine attack wherever it happens. Since stress is a migraine trigger for many people, this alone can work as a preventive measure.

How to use a migraine injection pen

When your doctor prescribes medication that can be administered with a migraine injection pen, they will give you detailed instructions about using it. You will also receive instructions from the pharmacist upon filling the prescription.

If you have any questions, ask them before going home. While it's easy to find YouTube videos that show how to use a self-injection pen, comprehensive in-person instructions are more effective. The pen should come with instructions as well.

The procedure may depend on the type of pen you use. In most cases, you need to screw the cap off, push the pen into your skin at a specified angle, press a button to release the needle, hold it in place briefly, and then remove the pen from your skin and discard it safely.

There are a few things you need to know before using a migraine self-injection pen, including:

• Always clean the injection site first with alcohol wipes.

• Use the pen right after removing the cap — don't wait until later.

• Keep the pen away from children and pets.

• Make sure you store the pen strictly according to the instructions.

• Don't make injections into areas that have bruises, rashes, or hard spots.

• Don't inject the medication if it has flakes or lumps in it.

• Don't use the medication if it's cloudy or discolored.

• Never use a disposable pen if the safety seal is broken.

• Discard the disposable pen right after use.

If you face a problem with a pen, don't use it. Call your doctor's office for instructions or to set up a consultation.  

Medications used in migraine injection pens 

A doctor may suggest you use a self-injection migraine pen containing certain medications.

Triptans

Triptans⁵ are medications that can alleviate migraine symptoms during the attack. They work by stimulating serotonin receptors in the blood vessels. These drugs can block the transmission of the pain signal and initiate the constriction of blood vessels that are often dilated during the migraine headache.

For the medication to work, you must take the first dose when the pain starts to develop. When you take triptans orally, they can start working within an hour. With an injection, you can experience their effect in ten minutes.

You can repeat the injection after two to four hours if the effect of the medication wears off. If you don't get relief in the first place, a second dose isn't likely to make a difference. So it's good to let your doctor know.

The most common triptan drug, which is available in self-injection pens, is sumatriptan.⁶ It's available under several brand names. 

Dihydroergotamine mesylate

Dihydroergotamine⁷ is in the class of drugs called ergot alkaloids. It also works by constricting blood vessels in the brain that are usually dilated during a migraine headache. 

Your doctor may suggest taking dihydroergotamine every hour for two more doses if the headache continues. However, you shouldn't exceed three doses in 24 hours. This medication can't be used daily. It's important to follow your doctor's instructions carefully to avoid overdosing. If used too often, the medication can negatively affect your heart and other organs.

The brand name for the dihydroergotamine mesylate autoinjector is D.H.E. 45. It has a variety of contraindications that you should be aware of. When speaking to your medical professional about this medication, tell them about any other migraine treatments you may be on. For example, D.H.E. 45 and sumatriptan can't be administered together.

An injection of dihydroergotamine can prevent the headache from returning for 24 hours. However, the duration of its effects can vary from person to person.

Calcitonin gene-related peptide monoclonal antibodies

Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) were used to create a drug specifically designed to prevent migraines. Before that, the only preventive options were medications developed for other conditions that happened to also reduce migraine occurrences.

When a migraine strikes, your brain releases several substances, including calcitonin gene-related peptides. They are involved in various processes that initiate a migraine, including dilation of the blood vessels and swelling. These processes cause or contribute to migraine pain.

CGRP mAbs target CGRP and prevent a migraine from developing. Depending on the CGRP mAbs medication your doctor prescribes, you can self-inject either monthly or once every few months.

The common CGRP mAbs medicines that scientists studied for migraine prevention purposes are:

• Erenumab (Aimovig)

• Fremanezumab (Ajovy)

• Galcanezumab (Emgality)

Your doctor may prescribe one of these options for migraine prevention purposes. It's imperative to follow instructions closely to avoid unnecessary side effects.

How long does the effect last?

The duration of the migraine injection pen's effect depends on the medication inside. Medications that prevent the onset of a migraine usually maintain their effect for around a month. Drugs used during the attack can prevent the headache from returning for several hours.

It's important to remember that if the medication doesn't work, you shouldn't administer another dose unless your doctor approves it. Overdosing on migraine medication can lead to serious side effects. And for some drugs, if the first dose doesn't work, the second isn't likely to do so either.

Common migraine injection pen drugs: side effects

The duration and side effects of each migraine medication differ. It's important to discuss them individually with your doctor. Make sure to share your full medical history to avoid any unexpected reactions.

Remember that since you inject the medication on your own, you likely won't have access to immediate medical assistance. 

Let's take a closer look at the common migraine injection pen drugs and their side effects.

IMITREX STATdose pen

Imitrex⁸ is a triptan. You can use an injection pen containing this drug to alleviate the acute symptoms of migraine once they start. It will not work as a preventive measure. If this medication doesn't get rid of or improve your migraine symptoms or you experience side effects, check with your doctor to make sure you are using it correctly or ask for an alternative.

The milder side effects of a sumatriptan injection are:

• Dizziness

• Weakness

• Feeling warm or cold

• Numbness and/or tingling in fingers and toes

• Nausea, vomiting

• Sleepiness

• Local reactions at the injection site (redness, swelling, pain, stinging)

• Allergic reactions (from itching to swelling)

Serious side effects of sumatriptan injection pens are:

• Arrhythmia (heart rhythm disturbance). This problem can occur within a few hours after administering the medication. You should get immediate medical assistance because arrhythmias can cause serious effects.

• Tightness, pressure, or pain in the chest, throat, neck, or jaw. While not always signs of a heart problem, these symptoms warrant an evaluation of your cardiovascular system.

• Stroke. This rare side effect usually occurs when the patient's migraine is misdiagnosed.

• Serotonin syndrome. Symptoms of this side effect include agitation, hallucinations, coma, tachycardia, hyperthermia, nausea, and vomiting. It can occur within minutes or several hours after the injection.

• Blood pressure spike. This rare symptom may occur in patients with a history of hypertension.

• Seizure. This may occur in patients with or without a history or predisposition to seizures.

How long does a sumatriptan injection take to work?

You can start feeling the effect within ten to 15 minutes, but its full effect usually occurs within one hour.

D.H.E. 45

D.H.E. 45 is the brand name of a dihydroergotamine mesylate autoinjector that works to alleviate migraine pain. While effective for migraines and cluster headaches, doctors don't recommend using this drug daily.

D.H.E. 45 can interact with other drugs that you take for migraine attacks or other conditions. Make sure to discuss all of your current medications with your doctor.

The mild side effects of D.H.E. 45 injections are:

• Nausea

• Local injection site reactions (swelling, redness, pain)

• Leg cramps

Serious side-effects of using D.H.E. 45–filled injection pens include:

• Allergic reactions. In some individuals, the medication can cause a serious allergic reaction, such as difficulty breathing and swelling of the face, throat, tongue, and lips.

• Overdose. An overdose of this medication can be fatal. Doctors prescribe the dosage based on your symptoms and medical history. If you overdose, call 911 immediately.

• Heart attack, stroke, and hypertension. These side effects are rare. However, if you feel severe dizziness, muscle cramps, your headache getting much worse, or weakness, numbness, pain, or cold in your hands and feet, call 911 immediately.

This migraine medicine has numerous contraindications, including heart and coronary artery disease, history of heart attack or stroke, uncontrolled hypertension, allergies to ergot medications, and blood circulation problems. Make sure to share your existing or past medical issues with the doctor prescribing the medication.

If you are taking another migraine medication, such as sumatriptan, don't take D.H.E. 45 within the 24 hours following its use.

How long does a D.H.E. 45 injection take to work?

You should start feeling relief within one hour of the injection. If, after that time, the headache persists, you can take two more injections spaced at least an hour apart.

If you still feel a headache after three injections, call your doctor. You should not use more than three D.H.E. 45 pens in 24 hours or more than six injections per week.

Emgality

Emgality⁹ is a CGRP mAbs autoinjector pen. Your doctor may prescribe this medication as a preventive measure for migraine attacks. To start the treatment, the manufacturer recommends administering two consecutive doses. After that, you can take single injections monthly. Pens come prefilled with a single dose.

Mild side effects of Emgality injections are:

• Injection site reactions (rash, itching, redness)

Serious side effects of using Emgality injection pens:

• Severe allergic reactions. Theseinclude rapid heart rate, swelling of the face, tongue, or lips, and difficulty breathing.

• Overdose. If you overdose on Emgality, you may experience trouble breathing and dizziness. This condition requires immediate medical attention.

Emgality may interact with other medications. Make sure to tell your doctor about your current treatments. If you are pregnant or breastfeeding, your doctor may not prescribe this medication since its effects on the fetus and the baby are currently unknown.

How long does an Emgality injection take to work?

This medication usually starts working within one month after the first two injections. However, it may take up to three weeks for the patient to notice the effect.

Should you ask your doctor about trying a migraine injection pen?

A subcutaneous injection delivers the medication to your bloodstream faster than the oral route of administration. That's one of the reasons why your doctor may recommend a migraine injection pen both for preventive measures and for acute treatment.

Most drugs delivered through an autoinjector pen have serious side effects and numerous contraindications. It's up to your doctor to weigh all the pros and cons of using this pen in your specific case.

You need to understand that the effectiveness of each injection pen depends on the drug inside it. For some people, these drugs may relieve symptoms. For others, it may not work at all.

If you start using a migraine injection pen and experience side effects, your doctor can prescribe other effective measures for controlling your condition.

The lowdown

Migraine injection pens are a safe and effective way to deliver symptom-relieving and preventive medication to your body. These pens are easy to use and don't require a doctor's supervision.

Studies demonstrate that self-injection pens are safe for patients with minimal instruction. However, it is important to remember that the medication inside these pens can cause various side effects.

Talk to your doctor to determine whether a migraine injection pen is a right choice for your migraine management.