Living with Migraines Pt. II: Emgality

This is a follow-up to my December 2020 post A Persistent Pain: Living with Migraines. If you wish to learn more about my life with migraines, please read that first. Thank you!

Emgality in box. Photo by author.

Finally Seeing a Neurologist:

I have had migraines since I was a child. I have been asked countless times if I have seen a neurologist and/or had an MRI, but I was never able to. In late May of 2021, I had my first ever appointment with a neurologist and an MRI was scheduled. As he learned my medical history, especially my trials with medications, he agreed that I have tried every pill option for a patient with migraines. The next step was to try one of two injectable medications: Botox or Emgality. As someone terrified of needles, I was hesitant but willing to go through with it. Since Botox requires several shots in a single session while Emgality is one shot every month, I opted for the latter.

Prescriptions: Take 4

Manufactured by Lilly, Emgality comes in an autoinjector and can be done at home.

Instructions:

Emgality pen. Photo by author.

It should be refrigerated while stored. When it’s time to use it, let the device warm to room temperature, naturally. It helps ensure that it isn’t as painful. It can be injected into the back of the arm, thigh, buttocks, or abdomen. The key is to use somewhere that has some fat. In the meantime, icing that area helps, immensely. Ten minutes is enough, but the longer the better, as long as the spot isn’t already in pain from the ice. Wiping the area with alcohol and letting it dry is important, as well.

When you’re ready for your injection, twist the cap off the base in the same direction as the arrow. Place the plunger flat against your skin. Next, twist the bottom to unlock the needle and secure the device against you. Last, use your thumb to press and hold down the teal button. The first click that is heard is during the injection. Keep the plunger steady for about ten seconds, until you hear the second click indicating that the needle has been retracted. The injection is complete. The pen goes into a plastic tub or sharps bin, if available. Emgality provides free bins, if you request it.

Emgality after use. Photo by author.

The first month was the most difficult for me. Not only does it involve two doses, but it took approximately two hours for me to finally work up the courage to press the button that releases the needle. Once I finally pressed it, I did yelp. The first of the two clicks made by the device caught me off-guard. The sound of the click is louder than I had anticipated and since the needle springs forward, it goes in quickly. After the first shot, I remember laughing a lot. It didn’t hurt. It was merely unexpected. It took less time to do the following injection for that month, after experiencing it. The second injection hurt a bit, but not severely so. The reason for that was not icing it for as long or holding it as securely.

Each month, I still have fear and hesitation. There is still an assumption that it will hurt more than it ever does.

Some people have said it’s “very painful;” however, I disagree. Even in the two times now that it has been painful, it wasn’t overwhelmingly so. Plus, that bit of pain subsided after minutes. In my experience, sometimes the medication hurts more and for a little longer than the needle, much like a flu shot. Generally, the injection doesn’t bleed, either. Sometimes, if the positioning of the needle is off or if it doesn’t retract as smoothly as it’s supposed to, it will bleed a bit.

Advice:

Before my first doses on June 6th 2021, I watched videos for advice on performing the injection to know what to expect. I read comments under those videos, as well.

The first video I watched was by The Frey Life. I had not seen their videos before. Their content consists of vlogs by the married couple. The wife, Mary suffers from Cystic Fibrosis. This past December, she was put on Emgality for migraines. As the video documentation of her first dose explains, she is familiar with needles; therefore, I felt and still feel that her reaction and explanation is more informative than someone who isn’t, like myself.

Facing Anxiety

All my life, I have had a phobia surrounding needles. I will obsess about any future shots, until they’re done. Then, I will focus on the one coming after that. Please, don’t feel shame for being afraid of needles. You are valid. If you relate, please keep reading.

Luckily, at this time, I was given great advice by a therapist. Since this device keeps the needle inside the pen, preventing accidental sticks, and I have to keep the used pens in a bin until it is full and ready to be dropped off for disposal, I have access to old pens. Using an old pen, I was able to follow my therapist’s instructions to practice. Her instructions were to physically go through the steps of doing the injection, minus the actual injection, and tuning into how I feel, without denying my fear. My initial fear of handling the pen, removing the cap, and placing it against my skin went away through this. Then, oddly enough, through admitting to myself that this is terrifying for me, I have been able to more easily face my anxiety and perform the injection. I encourage anyone going through this to try it, as well. Like my therapist explained, this doesn’t remove all anxiety from needles, but it makes it so that you’re not paralyzed, like I was.

Results

The results of my MRI were normal. There was no sign in my brain that points to a cause for my lifelong migraines. This is what I expected.

After the first month with Emgality, my migraines were cut in half. I used to get 25-30 migraines per month. I was down to 15; unfortunately, in August I had a mishap with the autoinjector. I was so nervous about the potential of the pain that I thought if I did something unrelated with my left hand while holding the device and pressing the button with my right, it would make it easier. Sadly, the plunger wasn’t firmly against my skin and the needle didn’t go in correctly. I did feel the injection; however, the medication ran down my side, instead. If you’re afraid of needles like I am, I recommend holding the plunger with your other hand.

In the event that a patient is unable to use their pen, Lilly provides replacements; however, my insurance will not cover replacements; therefore, I was unable to have the dose for that month. I believe that this is why my migraines increased a bit, again. After receiving my dose for September, my migraines are mostly stable, like before.

My hope is that this post will ease some of the fear surrounding needles; especially, for anyone who needs to start Emgality. Needles terrify me, but I bravely and successfully take injections once every thirty days for my migraines. I believe in myself, and I believe in you.

Editor’s Note: This is an original post by this author in 2021.

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