What treatment can help manage my chronic migraine?

Question

Hello doctor,

I have had chronic migraines for fifteen years, with more than twenty migraine days per month. The migraines are severe, throbbing pain, nausea, vomiting, sensitivity to light and sound, visual auras, and they last twenty-four to seventy-two hours. I have tried every preventive medication, and nothing works. I am missing work constantly, and my neurologist mentioned migraine injections.

What are migraine injections?
How does botulinum toxin prevent migraines?
Where do they inject botulinum toxin?
How often do I get injections?
What are Erenumab and Galcanezumab?
Are these monthly or quarterly?
Can I do self-injections at home?
Which is more effective?
What are the side effects?
Will insurance cover them?
What if they do not work?
Could my migraines be hormonal?
Should I get an MRI scan?
Is there any chance these injections will finally give me my life back?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

You have chronic migraine with more than twenty days per month, and that makes you an excellent candidate for migraine injections. These treatments are designed for people who do not improve with tablets.

There are two main types of migraine injections: botulinum toxin and calcitonin gene-related peptide inhibitors. Both reduce the frequency and intensity of attacks, but they work in different ways.

Botulinum toxin relaxes overactive pain nerves in the head and neck. It is injected into specific muscles of the forehead, temples, back of the head, neck, and shoulders. The procedure takes about ten to fifteen minutes and is done in the clinic every twelve weeks.

Calcitonin gene-related peptide inhibitors, such as Erenumab, Fremanezumab, Galcanezumab, and Eptinezumab, block a pain-triggering chemical released during migraines. These are given once a month, or once every three months, depending on the generic version. Most can be self-injected at home.

Both treatments are effective, but in patients with very frequent migraines like you, botulinum toxin and calcitonin gene-related peptide inhibitors can also be combined if needed. Your neurologist will choose based on your symptoms, cost, and insurance.

Side effects are usually mild. Botulinum toxin may cause neck soreness or a mild headache for a day. Calcitonin gene-related peptide injections may cause injection-site pain or constipation in a few patients. Serious side effects are rare.

Insurance often covers these treatments for chronic migraine, especially if you have failed several preventive medicines. Your neurologist’s office usually handles the approval paperwork.

If one treatment does not work, we can switch to another. There are multiple calcitonin gene-related peptide options, and sometimes combining or changing the type gives excellent results. Hormonal fluctuations can definitely worsen migraines, especially around periods, but this does not stop you from benefiting from botulinum toxin or calcitonin gene-related peptide injections.

You already have a long migraine history, but if you have not had a magnetic resonance imaging scan, your doctor may order one to rule out other rare causes. Most chronic migraine patients have a normal magnetic resonance imaging scan.

Yes, there is a chance that injections can give you your life back by reducing attack frequency, shortening duration, and restoring your ability to work and function normally. I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.