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.
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.