I am 29, female. Are injections effective for my migraine?

Question

Hello doctor,

I am a 29-year-old woman with migraines with aura that have intensified over the past year, now occurring around eight to ten times a month. I experience visual disturbances, nausea, and sensitivity to light and sound, and triptans are no longer consistently effective. I have read about preventive treatments like calcitonin gene-related peptide (CGRP) monoclonal antibodies, but I do not know how they compare with oral preventives like beta-blockers or anticonvulsants. Are these injections suitable for long-term use, and what are the insurance and access considerations involved?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your symptoms suggest chronic migraine with aura, especially since attacks occur eight to ten times a month and are now less responsive to triptans. When migraine attacks are this frequent, we usually add a preventive medication to reduce how often and how severe they become. Traditional oral preventives include:

Beta-blockers (like Propranolol or Metoprolol) are helpful if you also have anxiety or palpitations.
Anticonvulsants (like Topiramate or Valproate) are effective but may cause drowsiness, weight change, or tingling.
Tricyclic antidepressants (like Amitriptyline) are useful if sleep or mood is affected.

These are affordable and easily available, but they may take several weeks to show benefit and can have systemic side effects.

Calcitonin gene-related peptide (CGRP) monoclonal antibodies (Erenumab, Fremanezumab, Galcanezumab, Eptinezumab) are newer, highly targeted injections given once a month or every three months. They block the calcitonin gene-related peptide (CGRP) pathway, which is central to migraine pain signaling. They are very effective for patients not responding to oral drugs; fewer systemic side effects. Well tolerated and suitable for long-term use; no effect on blood pressure, mood, or weight. The cost can be high. Many insurance plans require you to have tried and failed at least two oral preventives before approving calcitonin gene-related peptide (CGRP) therapy. Some companies offer patient assistance programs.

Maintain regular sleep, hydration, meals, and reduce caffeine. Magnesium, vitamin B2 (Riboflavin), and mindfulness or stress-management therapies can further help reduce attack frequency.

If oral preventives have not worked or caused side effects, calcitonin gene-related peptide (CGRP) monoclonal antibodies are an excellent next step. They are safe for long-term use, but insurance approval and cost are the main hurdles that your neurologist can assist with prior authorization.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.