DHE Injection DIY
For some of us, triptans don’t work as an abortive medication during a migraine attack. The next option a doctor may suggest is DHE (dihydroergotamine). While this medication can be prescribed in a nasal spray form, it can be delivered via IM or intra-muscular. This requires filling a syringe of the liquid form and injecting yourself- old-school style. These are not pre-loaded as some other rescue medications.
WARNING: If you are squeamish about needles, don’t watch this video on how to self-administer an injection of DHE using a syringe. Below is a written list of supplies, step-by-step instructions, and tips on how to do it yourself.
Disclaimers: I’m not a doctor. Per my doctor’s instructions, this is how I have been administering these shots for about six years. Practice needle safety. Make sure no pets, children, or other living creatures are near or around your workspace. Take off the guard on the needle only when ready and immediately replace it once the injection is complete. No one was harmed in the filming of this video and my intentions are to provide educational support (i.e. no drug company asked me to do this!)
Two headache specialists were consulting on the video and content. They provided additional commentary and alternatives:
Headache Specialist #1
"Some pharmacists advocate for using a blunt filter needle for drawing up medication from a glass vial. The necessity of this is up for debate and we have always done without and our patients have done just fine."
Headache Specialist #2
"The injection can be done from the top of the quad muscle. The hamstring is generally avoided to avoid injecting a nerve (so super rare). If it is subcuatenous injection, you can go anywhere under the skin, but the technique is different (not so deep).
Another trick is when you inject, if you want, you can squeeze the muscle rapidly to get the medicine dispersed, however make sure to keep your hands away from the needle to avoid potential contact."
- Cotton Balls
- Rubbing Alcohol
- Paper towels
- Small adhesive bandage
- 1 glass vial of DHE (prescription required)
- Syringe (prescription required) *I recommend a syringe that holds more than 1ml
- Anti-nausea medication (prescription required)
- Before starting the process, consider taking an anti-nausea medication prescribed or recommended to you by your doctor. Immediately after administering the injection, you could get very nauseous.
- Put a generous amount of rubbing alcohol on a cotton ball to disinfect the general area where you plan on injecting into your thigh.
- Take out the glass vial of DHE. Make sure all liquid is at the bottom of the vial. See “Tips” below if you run into problems.
- Wrap a paper towel around the upright vial. Place your thumb in the middle of the vial and apply pressure to break the top off. Always break away from you.
- Place bottom part of the vial that contains the liquid on a flat surface. Place the empty top of the vial in a safe place to dispose of later.
- Next, open the package containing the syringe. Using one hand, place three or four fingers around the middle of the syringe. Carefully take off the plastic guard from the needle.
- In the other hand hold the DHE vial, while putting the needle into the vial with the other. Use your thumb (and maybe forefinger) to move the stopper of the syringe upward. This will create a vacuum effect, transferring DHE into the syringe. See “Tips” below to troubleshoot issues. It takes practice to get it all transferred on the first try.
- Make sure there is no air pocket between the liquid in the syringe and the needle.
- Time to be brave! Identify exactly where you want to stick the needle in your thigh. Push the needle into your skin until you can no longer see the needle (or else the liquid could get stuck just under the skin, defeating the purpose).
- Use your thumb to push the stopper all the way down until all liquid is gone. Not gonna lie, this can sting. See “Tips” for ways to make it less painful. Immediately put the plastic guard back on the needle.
- It’s possible that a small amount of liquid could seep out of the injection site or you could bleed (very minimal!). Use a new cotton ball with rubbing alcohol to disinfect the area again. Use a small adhesive bandage if you need it.
- Lastly, account for all of your supplies. Most importantly, make sure the plastic guard is on the needle, you have both halves of the broken DHE vial. Dispose of all supplies safely.
- NOW, GO TAKE CARE OF YOURSELF!
- All DHE liquid needs to be at the bottom of the hourglass shaped vial before breaking it open. If the liquid is stuck at the top, use two fingers to flick the vial until the liquid falls to the bottom. This can take several tries. You can also try gently shaking it to release the liquid to the bottom.
- When suctioning the liquid from the vial, you may not get it all the first try. Stop, put the vial down. Hold the syringe with the needle facing the ceiling. Flick the top of the syringe, near the needle, to release any liquid. Then push the stopper up to release the air bubble. Try again to suction out the remaining liquid.
- If a small amount of liquid releases from the needle during this process, it’s ok.
- Once the needle is in the thigh muscle and you are pushing the medication through, I find the faster the better. Also, a nurse told me to use my other hand to pat my thigh in order to relax the muscles.
- Right after the injection is complete, it may sting for 30 seconds or less. Use your hand to rub the injection site to help with the discomfort. Then disinfect the site again with rubbing alcohol.
- The injection site could be uncomfortable for a few days, just be gentle. It could also create a small bruise.
- If the injection site becomes red and itchy, keep an eye on it. This can happen when a vial of DHE that has particulate matter in it (meaning it has formed crystals in it). If it continues to swell or gets worse, consult your doctor.
When it comes to planning vacations or other events where travel is required, how much does migraine factor into your decision-making?