What is a recommended injectable medication for migraine headaches?

Injectable Medications for Migraine Headaches

Subcutaneous sumatriptan 6 mg is the recommended injectable medication for acute migraine treatment, providing rapid and highly effective relief within 60-120 minutes. 1, 2

First-Line Injectable Treatment

Subcutaneous sumatriptan 6 mg is the gold standard injectable therapy for migraine attacks. 1, 2 This recommendation is based on:

• FDA approval specifically for acute treatment of migraine attacks with or without aura 2
• Strong guideline support from the U.S. Department of Veterans Affairs and Department of Defense for short-term migraine treatment 1
• Rapid onset of action with 70-80% of patients experiencing headache relief within 1-2 hours 1, 3
• Superior efficacy compared to placebo, with 47-54% more patients achieving headache relief 3

Clinical Efficacy Data

The evidence for subcutaneous sumatriptan is robust:

• Response rates of 72-79% at 60 minutes post-injection 3
• 86-92% improvement in headache severity by 120 minutes 3
• Effective regardless of migraine type, duration of symptoms, or baseline severity 4, 5
• Relief of associated symptoms including nausea, vomiting, photophobia, and phonophobia 5

Administration and Dosing

The recommended dose is 6 mg subcutaneously at the onset of migraine symptoms (though it may be given at any time during an attack). 2

• Inject into fatty tissue areas (thigh or upper arm) 2
• Hold the auto-injector firmly against skin for at least 5 seconds to ensure complete medication delivery 2
• A second 6 mg dose may be given if headache recurs, though approximately 40% of initial responders experience recurrence within 24 hours 4, 5

Important Safety Considerations and Contraindications

Sumatriptan is contraindicated in patients with cardiovascular disease. 2 Specifically avoid in:

• Documented ischemic or vasospastic coronary artery disease 2
• Previous myocardial infarction 2
• Prinzmetal (variant) angina 2
• Uncontrolled hypertension 2
• Hemiplegic or basilar migraine 2

For patients with cardiac risk factors (hypertension, hypercholesterolemia, smoking, obesity, diabetes, strong family history of CAD, postmenopausal women, men over 40), the first dose should be administered in a medically supervised setting with ECG monitoring. 2

Common Pitfalls to Avoid

• Do NOT administer during the migraine aura phase - wait until headache begins 4
• Do NOT combine with ergotamine-containing medications or methysergide due to risk of prolonged vasospasm 4
• Do NOT use concurrently with MAO inhibitors or within 2 weeks of discontinuing MAO inhibitor therapy 1
• Monitor for serotonin syndrome if patient is taking SSRIs or SNRIs concurrently 1

Tolerability Profile

Subcutaneous sumatriptan is generally well tolerated: 5

• Injection site reactions (minor pain, redness, bruising) occur in 10-40% but are typically mild and brief 6, 5
• Chest symptoms (tightness, pressure) occur in 3-5% but rarely indicate myocardial ischemia 4, 7
• Most adverse events are transient and resolve without intervention 4

Alternative Injectable Option for Cluster Headache

For cluster headache specifically, subcutaneous sumatriptan 6 mg is also highly effective, with 74-75% of patients achieving relief within 15 minutes. 1, 7 This is notably faster than the response seen in migraine attacks.