Injections of sumatriptan (Imitrex) are very underutilized. Many doctors fail to offer this option to their migraine and cluster headache sufferers because they are not aware of this option or more often because they are not aware how debilitating migraines can be or because they consider it to be dangerous. Patients who wake up with a severe headache (migraines commonly occur in the morning) and have to go to work or take care of their children often become disabled for the day because oral medications are not effective. Another group of patients who benefit from injections are those with nausea and vomiting. But you do not have to have a severe attack or have vomiting to take an injection. I have occasional migraines, usually triggered by wine or lack of sleep and if I take an oral medication it will usually help, but it may take an hour or even two before it works. So, if I have a headache late in the evening, I take an injection which stops my migraine within 10 minutes and I can fall asleep right away instead of waiting for an hour before the tablet takes effect. Sumatriptan injection is the only drug approved for the treatment of cluster headaches and it is a true life saver for cluster sufferers.
It is very easy to give yourself an injection of sumatriptan. There are three different devices on the market. The oldest one is a little more cumbersome to use, which can be a factor when you are in the midst of a severe attack, but it costs the least and is more likely to be covered by the insurance. Another injector, Sumavel does not have a needle – the device shoots the medicine into the skin through a tiny hole. This device is easier to use but some people complain that it is more painful despite it being needleless. The third device, Alsuma is identical to the one used in the Epi-Pen and it is also very easy to use. Sumatriptan is also available in vials. Some people prefer to use vials for several reasons. First, they are cheaper, second, they may be less painful to inject since you can use a syringe with a smaller needle than the ones in autoinjectors and third, some people get excellent results and fewer side effects with a smaller dose and the vial allows them to use 2 or 3 mg. Being able to use 2 or 3 mg at a time is particularly useful for cluster headache patients who have one or two headaches a day for extended periods of time and don’t get enough injections from their insurer.
If you suffer from severe migraine or cluster headaches ask your doctor about injections of sumatriptan. The main contraindication is heart disease or multiple risk factors for heart disease, but otherwise it is a very safe medicine. In Europe tablets of sumatriptan are sold without doctor’s prescription.