How long does a migraine injection take to work?

Question

Hello doctor,

I am 36 and suffer from chronic migraines, get them 20 to 25 days per month, and it is debilitating. I tried everything oral - Topiramate made me stupid and caused weight loss, Propranolol dropped my blood pressure too low, Amitriptyline made me gain 30 pounds.

My neurologist recently started me on a monthly migraine injection called Erenumab, but I have only had two doses so far. Have not noticed much improvement yet in migraine frequency. Still taking Sumatriptan eight to ten times per month for breakthrough migraines.

The headaches are mostly hormonal - they get worse right before the period and during ovulation. My gynecologist suggested birth control to regulate hormones, but I tried that before, and it made my migraines worse.

I have young twins and cannot function as a mother when having migraine attacks. I had to quit my job because I missed too many days. The pain is mostly left-sided with nausea, vomiting, and light sensitivity. Botox injections were mentioned, but insurance denied them. How long before migraine injection starts working? Willing to try anything because this is ruining my life and ability to care for kids.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

I am really sorry you are going through this, and your situation sounds incredibly difficult. Chronic migraines that occur almost daily can be completely disabling, especially when they interfere with work and caring for children.

Since you have already tried several preventive medications and are now on Erenumab (Aimovig), it is important to know that these CGRP (Calcitonin gene-related peptide) monoclonal antibody injections can take time to show full benefit. Many patients begin noticing improvement after two to three months, but in some cases, it may take up to six months of consistent monthly dosing before a clear reduction in migraine frequency or severity occurs.

Because you have only had two doses so far, it is still early in the course of treatment. Continuing for a few more months gives a better chance to evaluate its true effect. If, after three to six months, there is no meaningful improvement, your neurologist may consider switching to another CGRP antibody, such as Galcanezumab, Fremanezumab, or Eptinezumab, as some patients respond better to one than another.

Since your migraines seem strongly linked to hormonal changes, your gynecologist and neurologist could work together to explore non-estrogen hormonal stabilization, such as a continuous low-dose progesterone-only option or GnRH (gonadotropin-releasing hormone) analogs in severe, refractory cases, though these require close supervision.

It is also important to continue using abortive therapy like Sumatriptan judiciously, ideally keeping it under 10 days per month to avoid medication-overuse headaches. For supportive relief, approaches such as magnesium or Riboflavin supplementation, relaxation therapy, regular sleep, avoiding known triggers, and physical therapy for neck tension can sometimes help reduce attack frequency.

Botox remains one of the most effective treatments for chronic migraine, so if possible, it might be worth appealing the insurance decision with documentation of your medication failures and severe impairment. You are clearly doing everything you can, and it is important not to lose hope, because with the right combination of preventive and supportive treatments, many patients eventually regain good control and quality of life.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.