Injection medication for migraines
Pro Research Analysisby 
Searched over 200M research papers
Injection Medication for Migraines: A Comprehensive Overview
Botox (OnabotulinumtoxinA) for Chronic Migraine
Botox, or OnabotulinumtoxinA (BoNT-A), has been extensively studied for its efficacy in treating chronic migraines. Research indicates that BoNT-A significantly reduces the frequency of migraine attacks, pain intensity, and the need for acute medication1 5 10. Patients receiving BoNT-A also report fewer emergency visits and improved quality of life. The treatment is well-tolerated, making it a viable option for chronic migraine sufferers1 6.
Calcitonin Gene-Related Peptide (CGRP) Inhibitors
Galcanezumab
Galcanezumab, a monoclonal antibody targeting CGRP, has shown promising results in reducing the number of migraine days. In a study involving patients with episodic migraines, monthly injections of Galcanezumab significantly decreased migraine days compared to placebo3. The treatment was well-tolerated, with injection site pain being the most common adverse event3.
Erenumab
Erenumab, another CGRP inhibitor, has also demonstrated efficacy in reducing migraine frequency. Patients receiving Erenumab experienced a significant reduction in migraine days and improved daily functioning compared to those receiving a placebo7. The treatment was generally well-tolerated, with similar rates of adverse events between the treatment and placebo groups7.
LY2951742
LY2951742, a fully humanized monoclonal antibody to CGRP, has shown efficacy in reducing migraine days in a phase 2 trial. Patients receiving LY2951742 reported a significant decrease in migraine days compared to those receiving a placebo9. Common adverse events included injection site pain and upper respiratory tract infections9.
Occipital Nerve Block (ONB)
Occipital nerve blocks (ONB) with corticosteroids and local anesthetics have been explored for migraine prevention. However, a randomized, placebo-controlled study found no significant difference in migraine frequency reduction between the ONB and placebo groups4. Despite this, ONB remains a consideration for some patients, particularly those with chronic migraines5.
Comparative Efficacy and Recommendations
A systematic review and practice guideline evaluated various percutaneous interventional treatments for migraine prevention. OnabotulinumtoxinA received a strong recommendation for chronic migraine prevention but a weak recommendation against use for episodic migraines5. Greater occipital nerve blocks received a weak recommendation for chronic migraine prevention, with a preference for local anesthetic alone over corticosteroids5.
Conclusion
Injection medications, including Botox and CGRP inhibitors like Galcanezumab, Erenumab, and LY2951742, offer effective options for migraine prevention. While Botox is particularly effective for chronic migraines, CGRP inhibitors show promise for both chronic and episodic migraines. Occipital nerve blocks may be beneficial for some patients, though evidence is less robust. Clinicians should consider individual patient needs, potential side effects, and treatment efficacy when prescribing these therapies.
Sources and full results
Most relevant research papers on this topic
Botox (OnabotulinumtoxinA) for Treatment of Migraine Symptoms: A Systematic Review
Botox is a low-cost option for treating various types of migraines, reducing migraine attacks per month and reducing pain severity.
Systematic Review
Rigorous JournalThe Acute Treatment of Migraine in Adults: The American Headache Society Evidence Assessment of Migraine Pharmacotherapies
Many acute migraine treatments have evidence supporting their efficacy, including triptans, dihydroergotamine, and various nonspecific medications.
Systematic ReviewRigorous Journal
Highly CitedEfficacy and safety of galcanezumab for the prevention of episodic migraine: Results of the EVOLVE-2 Phase 3 randomized controlled clinical trial
Galcanezumab 120 or 240 mg given once monthly is efficacious, safe, and well-tolerated for preventing episodic migraines.
RCT
Large Human TrialRigorous JournalHighly CitedOccipital nerve block for the short-term preventive treatment of migraine: A randomized, double-blinded, placebo-controlled study
Occipital nerve block with local anesthetic and corticosteroid does not significantly reduce the frequency of moderate to severe migraine days in patients with episodic or chronic migraine compared to placebo.
RCTRigorous JournalHighly CitedPercutaneous Interventional Strategies for Migraine Prevention: A Systematic Review and Practice Guideline.
OnabotulinumtoxinA is a strong recommendation for chronic migraine prevention, while trigger point injections and intrathecal medication are discouraged for migraine prevention due to insufficient evidence.
Systematic ReviewRigorous JournalBotulinum Toxin Treatment of Chronic Migraine - A Double Blind Study with a Novel Technique Employing Fewer Injections. (P4.124)
A novel injection technique with fewer injection sites significantly reduced headache pain days in chronic migraine patients.
RCTA Controlled Trial of Erenumab for Episodic Migraine
Erenumab, at a monthly dose of 70 mg or 140 mg, significantly reduced migraine frequency and improved physical impairment and everyday activities in patients with episodic migraine.
RCTLarge Human TrialRigorous JournalHighly CitedA double-blind, randomized, placebo-controlled comparison of botulinum toxin type a injection sites and doses in the prevention of episodic migraine.
Low-dose botulinum toxin type A injections into frontal, temporal, and/or glabellar muscle regions were not more effective than placebo in preventing episodic migraines, but were safe and well-tolerated.
RCTHighly CitedSafety and efficacy of LY2951742, a monoclonal antibody to calcitonin gene-related peptide, for the prevention of migraine: a phase 2, randomised, double-blind, placebo-controlled study
LY2951742 shows potential in migraine prevention, with a mean decrease in headache days of 62.5% compared to -3.0% in the placebo group.
RCTHighly CitedOnabotulinumtoxinA for treatment of chronic migraine: Results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial
OnabotulinumtoxinA effectively reduces headache frequency in adults with chronic migraine, with repeated treatments being safe and well-tolerated.
RCTLarge Human TrialHighly Cited