I Tried CGRP Inhibitors for My Chronic Migraines—Here's What Happened

Sitting in an exam room, my neurologist and I reviewed the long list of things we'd already tried to treat my chronic migraines. Supplements, hard-to-pronounce drugs, abortive and preventative medications, near-misses, and flat-out failures. 

Then, she suggested one more treatment option: Injections. It was a final push to get my head pain under control.

I was about two years into my migraine journey at that point. After years of sporadic migraines, I progressed to high-frequency episodic migraines. According to the American Migraine Foundation, that refers to headache activity 10 to 14 days per month—with more than a few episodes severe enough to send me to bed until my medications kick in. 

Given my severe symptoms, my neurologist said injections were my best option for relief. I had two choices: Botox injections every three months or self-administered anti-calcitonin gene-related peptide (anti-CGRP) injections once a month.

What Are CGRP Inhibitors?

According to my neurologist, anti-CGRP injections (also known as CGRP inhibitors) are supposed to cause little to no side effects. And because they are designed to specifically target the CGRP protein, believed to cause migraines, they also aren't supposed to interact with other medications.

On the other hand, I knew Botox for migraines was a blessing for some people, but I also knew others who weren't so lucky. For some, the treatment amounted to 30 shots at a time for months, only to show slight improvement and a few new side effects. 

So, I decided immediately to go with the CGRP inhibitors, which seemed like a promising migraine treatment. 

Of course, I still had reservations. It was 2018, and the Food and Drug Administration (FDA) had recently approved CGRP inhibitors. The thought of taking a relatively new drug made me nervous. But the fear of getting on yet another ineffective (potentially harmful) treatment outweighed any fear of trying something new. 

People with multiple medication failures are the best candidates for the drug. Still, the injections may not be suitable for everyone, so talk with your healthcare provider if you want to consider CGRP inhibitors for treating your migraines.

So, with my sample injection pens in hand, I left my neurologist's office and went home cautiously optimistic. 

The first month included an extra "loading dose", meaning a more potent initial dose to get the medicine to a therapeutic level. After my history of daily pills, dosage adjustments, and medication interactions, could the 10-second injection once a month finally give me some overdue relief? I was ready to try it—at least during the car ride home.

When Doubt and Anxiety Creep In

When I arrived home, I opened everything up and read the directions. Back in the exam room, my neurologist walked me through the steps to administer the medication, so I was somewhat familiar with the procedure. And with an instructional YouTube video I could watch, the process looked effortless. 

Then, dose in hand, I started spiraling with doubt and questions: 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 that point, the anxiety rabbit hole had opened and couldn't simply be closed again. Before I took the plunge and pressed the (literal) 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 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, which didn't help my decision-making process.

My fears about taking the drug didn't ultimately 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 migraines grew. I worried they'd continue getting worse. That I'd have chronic migraines 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 list of concerns, worries, and what-ifs. 

"What if this doesn't work?" I asked him. 

My reasonable, rational, level-headed husband responded, "Okay, but what if it does?"

Some Helpful Advice

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, so I didn't really have much to lose.

My husband returned to the bathroom with me and offered to give me the injections, but I wanted to do them myself. You should inject yourself in the upper leg, stomach, or buttock, and my leg seemed like the most accessible 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, but it lifted a weight off my chest too. There was no going back.

I've given myself six more injections since that first injection. 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 that my migraine frequency, severity, and duration have decreased.

CGRP injections aren't a cure—they're not designed to make chronic migraine disappear. But I've managed my migraine better in the last several months, which is more than I can say about any other treatment I've tried. 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 migraines. It's often an evolving health condition, changing with seasons, diet, hormones, sleep, age, and several other factors. Treating migraines 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 remember to be optimistic.

Ultimately, I can't predict what lies in my 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?"