A High-Tech Solution to Chronic Pain with the Migraine Vaccine

The migraine vaccine is an innovative preventive treatment that stops chronic headaches by blocking a specific protein in the brain responsible for carrying pain signals and triggering attacks. For patients who have spent years seeking relief through medications originally produced for other diseases, this high-tech method—developed specifically for the migraine mechanism—opens a new door of hope. For individuals whose daily lives are interrupted by severe attacks, it significantly improves the quality of life by noticeably reducing the frequency and severity of the episodes.

In Brief:

• It is a preventive treatment directly targeting the migraine mechanism, with galcanezumab as its active ingredient.
• It is administered subcutaneously (under the skin) once a month using a special auto-injector, much like an insulin pen.
• It is suitable for patients experiencing four or more attacks per month, with or without aura.
• It is not a traditional vaccine, but rather a monoclonal antibody drug that has a protective effect on the immune system.
• The treatment duration is generally planned between 6 months and 1 year, depending on the patient's response.

What is the Migraine Vaccine (Migraine Injection)?

Popularly known as the migraine vaccine or migraine injection, this treatment is the first medical intervention specifically designed to prevent chronic migraine attacks. In the past, medications for epilepsy, blood pressure, or depression were typically used to prevent migraines. However, this next-generation treatment focuses directly on one of the root causes of migraines. During migraine attacks, a substance called calcitonin gene-related peptide (CGRP) is heavily released in the brain. This substance causes the blood vessels in the brain's meninges to dilate and transmits severe pain signals. The newly developed treatment blocks the CGRP receptors, breaking this pain cycle before it even begins.

Actually a monoclonal antibody medication

This treatment method is not a conventional vaccine containing weakened microbes that provides lifelong immunity. Its active ingredient, galcanezumab, is a recombinant humanized monoclonal antibody produced in a laboratory setting using Chinese hamster ovary (CHO) cells. Therefore, it is much more accurate to define it medically as a "medication." Approved by the US Food and Drug Administration (FDA) in 2018 for the preventive treatment of migraines, this formula has also been safely used in Türkiye since 2021. Its highly targeted mechanism is what sets it apart from traditional drugs.

Causes and Risk Factors

Although the exact cause of migraines has not been fully mapped out, it is known to emerge from a combination of genetic predisposition and environmental factors. Individuals with a family history of migraines have a much higher risk of developing the condition. Changes in the brainstem and interactions in the main pain pathway, known as the trigeminal nerve, initiate the attacks. Stress, irregular sleep, skipping meals, bright lights, certain fermented foods, and the lodos—the warm southwesterly winds famously known in Istanbul for triggering headaches—are among the most recognized triggers.

Particularly in women, hormonal fluctuations, menstrual periods, pregnancy, or menopause directly affect the frequency of attacks. In the chronification process, the biggest risk factor is the unconscious and excessive use of painkillers during attacks. Over time, this lowers the brain's pain threshold, leading to a more complex condition known as "medication-overuse headache."

Migraine Symptoms and Attack Stages

A migraine is not just a headache; it is a neurological syndrome that affects the entire body. Attacks generally occur in four stages. The first stage, the prodrome phase, begins one or two days before the pain; the patient may experience unexplained fatigue, sugar cravings, neck stiffness, and frequent yawning. The second stage, the aura, occurs in about one-fifth of patients. Temporary neurological symptoms such as zigzag lines in the visual field, bright spots, or tingling in the face or hands are experienced.

The third stage, the actual pain period, is throbbing in nature and usually settles on one side of the head. During this process, nausea, vomiting, and extreme sensitivity to light, sound, and smell develop. The pain can last anywhere from 4 to 72 hours. In the final stage, the postdrome (post-attack) phase, the person feels exhausted, mentally foggy, and drained, almost as if they have just recovered from a severe illness. To learn more about the complex nature of this disease, you can review our article titled Discover the Secrets of Migraine: Causes Behind Severe Headaches.

Diagnosis: How is it Diagnosed at the Hospital?

Migraine diagnosis is not a condition that can be directly identified through blood tests or radiological imaging. The diagnostic process progresses with a detailed medical history taken by a specialist neurologist and a comprehensive neurological examination. The physician evaluates how often the attacks occur, how long they last, the character of the pain, and accompanying symptoms (like nausea or light sensitivity).

If the character of the patient's headache has suddenly changed, if a severe attack is experienced for the first time at an older age, or if different neurological findings are detected during the examination, imaging tests such as Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) are requested to rule out any other underlying dangerous conditions. Patients who experience headaches for more than 15 days a month, with at least 8 of those days having migraine characteristics, are diagnosed with "chronic migraine."

Chronic Migraine Treatment and Vaccine Administration

Treating chronic migraine requires a multidisciplinary approach. Making lifestyle changes, avoiding triggers, and establishing regular sleep habits form the foundation of the treatment. However, when these measures fall short, preventive medical interventions come into play. Offering a high-tech solution to chronic pain, the migraine injection steps in at this stage to make the patient's life easier.

Provided in special auto-injector pens, this treatment can be self-administered at home, much like an insulin injection. However, it is required that the first application be done in a clinical setting under a physician's supervision to monitor for any potential allergic reactions. When starting the treatment, the first dose is administered as a "loading dose," consisting of two consecutive injections. In the following months, it continues as a single dose injection each month. For patients who respond well, the treatment is generally maintained for 6 months to 1 year. Even after the treatment is discontinued, the reduction in attack frequency can last for up to 2 years.

Which migraine patients is it suitable for?

"Who can get the migraine vaccine?" is one of the most common questions we encounter at our clinic. This high-tech treatment is not for every headache, but rather designed for patients meeting specific criteria. This treatment can be safely preferred for the following patient groups:

• Those diagnosed with either migraine with aura or without aura,
• Those experiencing four or more severe migraine attacks per month,
• Those who do not respond to classic preventive treatments (like epilepsy or blood pressure medications) or cannot tolerate their side effects,
• Patients whose headaches have become chronic due to excessive painkiller use,
• Individuals diagnosed with cluster headaches who experience frequent attacks.

What are the side effects of the migraine vaccine?

As with any medical intervention, this treatment has some expected side effects. However, the side effects of the migraine vaccine are generally mild and temporary in nature. Clinical studies have shown that the vast majority of patients can comfortably continue the treatment. The main side effects that might be encountered are:

• Mild redness, swelling, or a temporary sensation of pain at the injection site,
• Mild symptoms resembling an upper respiratory tract infection, such as a sore throat or nasal congestion,
• Constipation, which can develop due to a slowdown in the digestive system,
• In rare cases, fatigue and mild muscle or joint pain.

The medication is considered safe for use up to the age of 75; however, it is not recommended for pregnant or breastfeeding women as there is insufficient data available.

Complications and Risk Groups

When left untreated, chronic migraine deeply shakes not only a person's physical health but also their psychological and social life. The constant fear of experiencing pain (anticipatory anxiety) can cause patients to disconnect from their work life, leading to social isolation and severe depression. Furthermore, painkillers taken uncontrollably to stop the attacks can eventually lead to serious systemic complications such as stomach bleeding, elevated liver enzymes, and impaired kidney function. Therefore, patients who need painkillers for more than four days a month must evaluate preventive treatment options without delay.

When to Seek Medical Help?

Although headaches are mostly benign, in some cases, they can be a harbinger of life-threatening diseases. It is vital to know the character of your pain well and seek rapid medical help in unusual situations. If you experience any of the following symptoms, you should go to the nearest emergency room without wasting time or call 112 (the national emergency number in Türkiye):

• If the most severe headache you have ever experienced in your life appears suddenly, within seconds (like a thunderclap),
• If the pain is accompanied by high fever, a stiff neck, mental confusion, or seizures,
• If there are stroke-like symptoms such as speech impairment, loss of strength, or numbness on one side of the body,
• If the headache started after a head trauma or a fall,
• If the severity of the pain reaches unbearable levels with coughing, straining, or sudden movements.

The Process at BHT CLINIC

At BHT CLINIC İstanbul Tema Hastanesi, we stand by your side in your fight against chronic pain with our advanced technology and expert staff. When you visit our hospital with a headache complaint, your process is meticulously managed by our Neurology clinic specialists. Dr. Ayşegül Daldal and our experienced medical team will perform your detailed neurological examination and determine the most appropriate treatment protocol for you. If deemed necessary, the migraine vaccine application is initiated in the safe environment of our clinic, under a physician's supervision. Additionally, our hospital's emergency department provides uninterrupted 24/7 service for sudden severe pains and neurological emergencies. You can easily schedule your appointment for treatment planning and examination.

Frequently Asked Questions (FAQ)

How much does the migraine vaccine cost and is it covered by insurance?

Because the migraine vaccine is a next-generation, high-tech biological treatment, its cost is higher than traditional medications. Under current regulations, this treatment is generally not covered by the Turkish Social Security Institution (SGK). However, some comprehensive private or international health insurance plans may cover the treatment depending on your policy terms. You can get up-to-date pricing information from pharmacies or our hospital's relevant departments.

How long is the migraine injection used?

The duration of the treatment is determined by the physician based on the patient's response to the medication. Generally, a noticeable effect is expected within the first two months. For patients who respond well, the treatment is continued for 6 months to 1 year. After the treatment is completed, the reduction in the frequency of attacks can continue for a long time.

Does the treatment completely cure migraines?

No medical treatment comes with a lifetime, one-hundred-percent guarantee to completely eliminate migraines. However, clinical studies have proven that in more than 50 percent of patients using the migraine injection, the number of pain days is cut in half, and the severity of the attacks is significantly reduced.

Does the migraine vaccine interact with other medications?

Galcanezumab, the active ingredient of this treatment, follows a different pathway than classic drugs that are metabolized in the liver. Therefore, it has no known interactions with other regularly used medications for blood pressure, diabetes, thyroid, or antidepressants. Nevertheless, it is absolutely essential that you inform your physician about all the medications you are taking.

Can I administer the injection myself at home?

Yes, the medication is sold in a special auto-injector (pen) form, and its use is extremely practical. Just like patients who administer insulin, you can apply it yourself at home as a subcutaneous injection in the thigh or abdomen. However, due to the risk of a potential allergic reaction, it is required that the first dose be administered in a hospital setting.

This article is for informational purposes only; please be sure to consult your physician for diagnosis and treatment. For appointments and detailed information, you can visit our website or contact us through our call center at 0850 811 34 00.