Migraine is a neurological condition that causes moderate to severe headaches. A migraine self-injection pen is a device that allows a person to self-administer migraine medication into tissues beneath the skin.
Migraine is common, affecting 39 million individuals in the United States and 1 billion people worldwide.
Pens can either be preventive treatment, containing medication to reduce the frequency and severity of migraine attacks, or an acute treatment containing medications to help alleviate migraine headaches that have already started. Some pens require only a click of a button.
This article describes what migraine self-injection pens are, the different types, their associated mechanisms of action, side effects, and costs.
Migraine self-injection pens contain one of three different types of drugs:
One example of an injectable triptan is sumatriptan, also available under the brand names Imitrex and Zembrace.
Dihydroergotamine mesylate (D.H.E. 45) is another option for alleviating acute migraine headaches. This medication works by constricting dilated blood vessels in the brain, working on serotonin receptors similarly to triptans.
Calcitonin gene-related peptide monoclonal antibodies
Calcitonin gene-related peptide (CGRP) monoclonal antibodies are medications that help to prevent migraine. They
Examples of CGRP monoclonal antibodies include:
The following section involves instructions on using the different types of migraine pens, including dosages and frequency of administration.
Imitrex is a type of triptan. A person should take the medication at the first sign of a migraine attack. However, people should not take it during the aura phase of a migraine, which some people experience before a migraine headache starts.
A person may take a second dose, but they must wait at least 1 hour after administering the first.
The maximum single dose of sumatriptan is 6 milligrams (mg). People should not exceed 12 mg within 24 hours.
The following are instructions for use:
- Twist and remove the safety cap.
- Put the needle guard on the injection site at a 90-degree angle. One possible injection site is the thigh.
- Firmly push the autoinjector as far as it will go.
- While holding the autoinjector, press the blue button until a click sounds and hold it for 5 seconds.
- Carefully remove the autoinjector from the skin.
An injection of D.H.E. 45 can help alleviate symptoms after an acute migraine headache starts. A doctor will prescribe the recommended dosage on a case-by-case basis.
A person should not administer a second dose within 6 hours of the first. Additionally, they should not use the medication every day or exceed a 6 milliliter (ml) dosage within a week.
The site of injection should be the thigh, well above the knee. A person should ask for instructions before self-administering the first dose since the procedure is not as simple as using other injection pens.
Emgality is a type of CGRP monoclonal antibody that aims to reduce the frequency and severity of migraine attacks.
The manufacturer recommends two consecutive doses of 120 mg as an initial dose or “loading dose.” Afterward, the dose is a single injection of 120 mg once per month.
When administering Emgality, a person can choose from the following injection sites:
- back of the upper arm
The following are instructions for use:
- Twist off the cap and hold the base against the skin.
- Turn the lock ring to the unlocked position.
- Press the teal injection button and hold it down until a second click sounds, about 10 seconds following the first click.
- Remove the injection pen from the skin.
Acute treatments that aim to alleviate the effects of a migraine attack are shorter acting than preventive treatments.
Imitrex provides relief from an acute migraine attack, and its effects last 1 day.
An injection of D.H.E. 45 usually prevents migraine headaches from returning within 24 hours.
Emgality is a preventive medication that a person takes once per month, suggesting that the effects last 1 month.
Most insurance companies will cover the cost of a migraine self-injection pen with a recommendation from a doctor.
Retail prices for the different types of migraine self-injection pens are as follows:
- Imitrex: A 1-ml dose is $438.
- D.H.E. 45: A 10-ml container is $12,295, which is $1,229 per unit.
- Emgality: A 120-ml dose is $665.
Generic versions of Imitrex and D.H.E. 45 are available at a lower cost. However, a generic version of Emgality is not yet available.
Below are the most serious risks and side effects of migraine self-injection pens.
Frequent side effects of Imitrex include:
Imitrex can also trigger serious cardiovascular events, such as heart attack and stroke. As such, the medication is not suitable for people with the following conditions:
- cardiovascular diseases, conditions involving the heart and blood vessels
- ischemic heart disease, or reduced blood flow to the heart muscle
- peripheral vascular syndrome, narrowing of a blood vessel outside of the heart
- uncontrolled high blood pressure
Learn more about the side effects of Imitrex here.
Potential side effects of D.H.E. 45 include:
- swelling and flushing around the injection site
- leg cramps
- pain at the injection site
D.H.E. 45 can cause cardiovascular events, such as heart attacks and heart arrhythmias. Although rare, some of these incidents have been fatal.
The medication may also cause spasms of the arteries within the heart and other areas of the body. These spasms may interrupt blood flow.
Because of the above risks, D.H.E. 45 is not suitable for people with preexisting cardiovascular disease or those with risk factors for such conditions. These risk factors may include:
Emgality may cause angioedema, which is swelling beneath the skin.
In some cases, the drug may cause a hypersensitivity or allergic reaction. The medical literature also reports cases of a severe and potentially life threatening allergic reaction known as anaphylaxis.
Possible signs and symptoms of anaphylaxis include:
- itchy skin rash or hives
- swelling of the throat
- difficulty swallowing
- hoarse voice
- tightness in the chest
- difficulty breathing
- stomach cramping
- pale skin coloration
- a feeling of impending doom
Migraine self-injection pens are devices a person can use to administer migraine medications. Some pens contain CGRP monoclonal antibodies to help reduce the frequency and severity of migraine attacks. Others contain drugs such as triptans or D.H.E. 45 to help alleviate symptoms of an acute migraine attack that has already started.
Evidence shows that migraine self-injection pens are both safe and easy to use. However, some injection pens can cause serious cardiovascular side effects. This makes them unsuitable for people with preexisting cardiovascular issues and those at increased risk of developing them.
A person considering using a migraine self-injection pen can speak with a doctor about the different options available.