Injection therapy and migraines – Part 2

Questions from the clinic: ‘I’ve heard about injections for chronic migraine, and I’d like to ask you some questions about it’

Please note as per TGA guidelines we are not permitted to mention the name of the product discussed in this blog entry

Part 2

Q How soon might I see a benefit?

A Patients may take 4 weeks after the injections to notice benefit, although they may see improvement sooner. In some patients a benefit may not be seen until after their second injection series.

Q May I take other medications for headache while I’m receiving injection therapy?

A Yes. Prompt treatment of acute migraine headaches with appropriate medications and in a frequency that will not cause medication overuse headaches is advised. Your migraine specialist will provide you with an acute migraine treatment strategy. This will assist the injection therapy to achieve a remission of your chronic migraine back to the episodic form of that headache disorder.

Q I am thinking about trying for a pregnancy in the next few months, can I still commence injection therapy?

A No, injection therapy has not been tested in pregnancy and therefore should not be administered to pregnant woman or in women who may become pregnant in the 3 months after it is injected. It should also not be used when patients are breastfeeding.

Q What happens after the first set of injections?

A Afterwards patients are able to drive home and resume normal activities. Vigorous neck exercises, neck massage, and or physiotherapy are however discouraged for 24 hours after the procedure.

There is good evidence that when it works, injection therapy has a cumultative effect, with better and better response with each cycle administered every 3 months across a year.
However after 2 injection cycles, as per PBS criteria, if no improvement is noticed, the injections should be discontinued.

Q: My injection therapy for chronic migraines has been working well, but I’m worried that it will stop being effective, what are the chances of this happening?

A A study that sought to answer this question was recently published by Cernuda-Morolion et al in Cephalagia 2015, Vol 35 (10):864-868 titled ‘Long-term experience with (injection therapy) in the treatment of chronic migraine: What happens after one year?

  • Only in around 1/10 patients did injection therapy lose their clinical efficacy after more than one year of treatment
  • There was no failure after the third year of treatment
  • In 43% of cases, injections can be delayed to every 4 months (16 weeks) after the first year of treatment

Note: Information on this site is not a substitute for professional medical advice

References:

Headache: The Journal of Head and Face Pain, 2014, American Headache Society, Tepper MD