What is the subcutaneous (subcut) medication for migraines?

Subcutaneous Sumatriptan for Migraine Treatment

Subcutaneous sumatriptan (6 mg) is the recommended subcutaneous medication for migraines, offering the most rapid and effective relief among all routes of administration for acute migraine attacks. 1, 2

Efficacy of Subcutaneous Sumatriptan

• Subcutaneous sumatriptan 6 mg provides pain relief in 70-80% of patients within 1 hour of administration 2, 3
• Onset of relief begins as early as 10 minutes following injection 2
• 63% of patients experience relief at 10 minutes and 73% at 30 minutes 2
• Approximately 65% of patients are completely pain-free within 2 hours 2

Advantages of Subcutaneous Administration

• Most effective route for rapid relief compared to oral, intranasal, and rectal routes 4
• Particularly beneficial when:
  • Severe migraine attacks occur 5
  • Significant nausea or vomiting is present 1, 5
  • Rapid relief is required 5, 6

Clinical Considerations

• The 2023 VA/DoD Clinical Practice Guideline specifically recommends subcutaneous sumatriptan (6 mg) for the short-term treatment of cluster headache 1
• Subcutaneous administration bypasses gastrointestinal absorption issues that can occur with oral medications during migraine attacks 2
• Headache recurrence may occur in approximately 40% of patients, but most respond to a second dose 7, 3

Dosing and Administration

• Standard dose: 6 mg subcutaneously 2
• Maximum daily dose: Do not exceed 12 mg in 24 hours 2
• Limit use to no more than twice weekly to prevent medication-overuse headache 1, 5

Important Contraindications and Precautions

• Absolutely contraindicated in patients with:

  • Ischemic heart disease or history of myocardial infarction 2, 3
  • Uncontrolled hypertension 1, 5
  • Basilar or hemiplegic migraine 1, 5
  • Concurrent use of ergotamine-containing medications or other triptans 3

• Cardiac monitoring is recommended for first-time use in patients with cardiovascular risk factors 2

• Most common adverse effects include injection site reactions (10-40% of patients), transient dizziness, and fatigue 2, 7

• Chest symptoms occur in 3-5% of patients and require immediate medical attention 3

Alternative Subcutaneous Options

• If sumatriptan is contraindicated, dihydroergotamine (DHE) can be considered as an alternative injectable medication, though it's typically administered intranasally or intravenously rather than subcutaneously 1

Subcutaneous sumatriptan remains the gold standard for rapid migraine relief when oral medications are insufficient or inappropriate, with extensive clinical evidence supporting its efficacy and safety profile when used appropriately.