I was sitting in my neurologist's office, as my doctor and I reviewed the long list of things we'd already tried to treat my chronic migraine—supplements and hard-to-pronounce drugs, abortive and preventative medications, near-misses and flat-out failures. Now, she was suggesting one more treatment option—a final push to get my head pain under control: injections.
I was about two years into my migraine journey at that point. After years of sporadic migraine, I had progressed to high-frequency episodic migraine—headache activity 10 to 14 days per month, with more than a few episodes severe enough to send me to bed until my medications kicked in. Given my severe symptoms, my neurologist said injections were my best option for relief, and I had two choices: Botox injections administered in-office every three months, or giving myself anti-calcitonin gene-related peptide (anti-CGRP) injections once a month at home.
I made my decision almost immediately: I'd go with the anti-CGRP injections—also known as CGRP inhibitors—a promising new treatment for migraine. I knew Botox for migraine was a godsend for some people, but I also knew others who weren't so lucky; that for some sufferers the treatment amounted to 30 shots at a time for months, only to show little improvement and a few new side effects. CGRP inhibitors, however, were supposed to cause little to no side effects, according to my doctor. And because they are designed to specifically target the CGRP protein, believed to cause migraine, they also weren't supposed to interact with other medications.
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Of course, I still had reservations. CGRP inhibitors were only recently approved by the US Food and Drug Administration (FDA) in 2018, and the thought of taking a brand-new drug made me nervous. The injections also aren't meant for everyone—according to Stewart Tepper, MD, a professor of neurology at Dartmouth Geisel School of Medicine in an interview with the American Migraine Foundation, people who have multiple medication failures (like me) are the best candidates for the drug. But the fear of getting on yet another ineffective (and potentially harmful) treatment outweighed any fear of trying something new.
With my sample injection pens in hand—the first month includes an extra loading dose, FYI—I left my doctor's office and went home cautiously optimistic. After my history of daily pills, dosage adjustments, and medication interactions, could this—a 10-second injection once a month—finally give me some much overdue relief? I was ready to give this a try—at least during the car ride home.
Once there, I opened everything up and read the directions. My neurologist had walked me through the steps on how to administer the medication in her office, so I was somewhat familiar with the procedure (for my blind spots, there was also an instructional YouTube video, which made the process look incredibly easy). But, dose in hand, I started spiraling: Had the testing on the medication been rigorous enough? Could I possibly inject myself the wrong way? If I did suffer side effects, how long would they last?
At this point, the anxiety rabbit hole had been opened and couldn’t simply be closed back up again. Before I took the literal plunge and pressed down on the injection button, I needed to know more about what I was getting myself into, so I did something you're not supposed to do: I played Dr. Google. I checked in on my favorite migraine resource groups on Facebook—a rookie mistake. The comment sections were split down the middle, with people who benefitted greatly from CGRP inhibitors, and those who did not, and they didn't help my decision process.
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My fears about taking the drug didn't completely stem from the unknown—I was also terrified of revisiting an all too familiar past with migraine medications. Each time I tried a new treatment that ended up not working, my fears about living with migraine grew bigger. I worried they'd continue getting worse; that I'd have chronic migraine forever; that I'd miss out on my family's important events, stuck at home in the dark with a lightning storm raging in my head. I wasn't sure I could handle another failed treatment.
Feeling anxious and dejected, I set aside the injections. When my husband came home from work, I reeled off a mile-long list of concerns, worries, and what-ifs. "What if this doesn't work?" I asked him.
My reasonable, rational, level-headed husband responded with, “Okay, but what if it does?”
He was right. I had no idea whether the injections would help me or not (and truthfully, I also didn't know if Botox injections would've helped, either). I was already uncomfortable, in pain, and missing out on large chunks of my life thanks to the effects of chronic migraine. I could get better on this new medication, or I could get worse, though not by much—I didn’t really have a lot to lose.
My husband came back into the bathroom with me and offered to give me the injections, but I wanted to do them myself. It’s recommended that you inject yourself in the upper leg, stomach, or buttock, and my leg seemed like the least easiest place. It took me a minute or two to work up the nerve to press down on the injection button over my thigh, and when I did, it hurt much more than I expected it would, but it lifted a weight off my chest, too. There was no going back.
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I’ve given myself six more rounds of injections since that first injection, and so far CGRP inhibitors have been a positive experience for me. I’ve had almost no side effects, except for injection site irritation (I have sensitive skin, so I end up with moderate swelling and itching for 48 hours after the injection; annoying, but manageable). I’ve also noticed an improvement in the frequency, severity, and duration of my migraine.
CGRP injections aren’t a cure; they’re not designed to make chronic migraine disappear. But I’ve been able to manage my migraine better in the last several months, which is more than I can say about any other treatment I’ve tried. But I also know that this treatment may not last. I could suddenly develop side effects or acclimate to the medication, making it useless.
In any situation, the future is always scary for people with migraine. It's often an evolving health condition, changing with seasons, diets, hormones, sleep, age, and a number of other factors. Treating migraine isn’t a matter of finding something that works and sticking with it forever. Feeling better can be fleeting—but so can feeling worse, if I’m remembering to be optimistic.
Ultimately, I can’t predict what lies in my migraine future. My episodes are tied to my hormones, so maybe when I go through menopause I’ll notice an improvement (a girl can dream, right?). For now, every 28 days, I do the only thing I can do: I take a chance this therapy will work. I say yes. I press down on the button and hope for the best. And when the voice inside my head says “What if this doesn’t work?” I force myself to ask the opposite question: “What if it does?”
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