How to Use Emgality Self-Injector

By Holly Harding

1 min read

Many of us are sent home with the Emgality self-injector, a delivery device for the CGRP treatment medication, after perhaps one demonstration by our physicians. This video is a demonstration to illustrate how to utilize the injection device.

In the comment section below, please share any questions or experiences you are having using Emgality or visit our forum on the topic here.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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223cf6 Member
I have been using emgality for 3 months now with great success!! By only issue is the medication burns so bad while it is injecting. the first couple of shots burned so bad they caused me to jerk and cut myself at the injection site. Now i get one of my daughters to give me the injection so I can hold on to something and prepare myself. I am NOT scared of shots and have given plenty to myself in the past but this IS painful while going in
1. Holly Harding Moderator & Contributor
 @224cf6- You are so right that this is a stinger going in! I tried Aimovig before this and could barely feel it (both going in, and in terms of efficacy!). But Emgality burns and stings a LOT going in, yet its efficacy is quite more pronounced such that I can get over that initial and very short-lived sensation since it means I'm experiencing my first windows of wellness in years. Thanks for the reality check on this point, Johnna.
katetyndall Member
Nice video, Holly. That’s exactly how I used to give myself Emgality. I actually did receive the loading dose at my migraine doc’s office, but I have to say, I made a better job of it than the tech did! I hope Emgality works for you without side effects. Like you, I tried Aimovig first. It didn’t work, plus I suffered extreme constipation, so after speaking with my neuro, we stopped it after two months. My hair loss (ultimately about 30% total loss—I’m lucky to be blessed with a lot to begin with...still, a real bummer) was also triggered by Aimovig and revived by Emgality, but that was something I discovered only in retrospect after looking back at a whole constellation of side effects. So, my Emgality experience... After I stopped Aimovig, my neuro suggested I try either Ajovy or Emgality, but he counseled me to wait 4 months before doing so. These drugs have a very long half life and although he said four months is a conservative approach, I was happy to do so. I started Emgality in late Jan. 2019 and took it for 3 months. My hair loss had finally tapered off the first three weeks of January. In a nutshell, Emgality worked for me. Although it didn’t get rid of my headaches, it enhanced the action of the abortives I did take. Even second and third tier drugs that I would resort to when I didn’t have my go-to triptan worked. I was able to reduce my use of triptans by 50%. That doesn’t mean I didn’t use them on a near daily basis; I did. It just means that if in the past I was taking 5mg of Zomig daily, with Emgality, 2.5mg would do the trick. I also would have a day or even two days in a week where I didn’t have a migraine. That hadn’t happened in the 10 years that my migraines had been chronic. And, the migraines I did have were somewhat less intense. I was delighted. I kept—and still keep—a very detailed log of my migraine journey since beginning with Aimovig in August 2018 and moving on to Emgality. The bad news was the side effects. There were a lot and they came pretty steadily. The constipation was horrific. My GERD, which had been in remission for years, returned with a vengeance that a two-week course of an OTC proton pump inhibitor wouldn’t touch. In the past, if I had a flare, a course of Nexium or Prevacid would knock it out, and I might not have another such flare—usually occasioned by stress—for a year. The hair loss that had abated by the beginning of January roared back to life in February 2019. I had been seeing a dermatologist about it since mid-October 2018, and we still hadn’t put two and two together. By the time I saw him, I had stopped Aimovig, and he didn’t think that was the source of the profound itching—super understatement there—and hair loss. Plus hair loss was not a listed side effect of Aimovig or of either of the other two CGRP antagonists. Then there was the itching. Of the skin on my body. All over. It was persistent and kept me awake at night. I thought I’d lose my mind. And the joint pains. Primarily fingers and wrists. The fingers were often so painful I’d have to rub them to try and straighten them out. Not fun. Not too much I could do about the wrists. The weird side effect, and the one that frightened me and caused me to do a deep dive into researching the role of CGRP in the body and what happens when you suppress it, was delayed wound healing. And I mean seriously delayed wound healing. I’m both clumsy and physically active, so I constantly have minor scrapes, cuts, abrasions, insect bites, you name it. And there was a trio of such back in March that provided much food for thought. I had a cut, an extremely minor burn—one finger hit the edge of the oven rack when I was removing a dish from the oven—and a bug bite that I scratched. All three exhibited an exaggerated response to what were minor insults to the skin, and took six weeks to heal. I was astounded and ultimately frightened. Both by what happened and what I read. My last dose of Emgality was April 25th. I told my neuro at our May appointment that I had quit it it, and why. He understood, and much of what I told him did not come as a shock to him. The skin finally healed, the hair has only recently stopped shedding, and the itching has resolved. The body itching was actually the first symptom to abate, about 30 days after I stopped Emgality. Unhappily, the constipation and GERD are still with me. In a further post, I will link to the first article that lays out in no small detail, the role CGRP plays in practically every system in the body, and the problems that might occur when CGRP is blocked. Reportedly, Aimovig blocks 89% of CGRP from being used by the body; Ajovy & Emgality block 85%. Even without the side effects I experienced, the information I found would have probably swayed me to stop taking Emgality in favor of a wait and see approach. My side effects made my decision for me. Even so, it was a tough decision to make, to turn my back on the first drug that has ever given me relief from chronic migraine. Ten years is a long time to have what has often felt like one long effing migraine, and in that light, dashed hopes are hard to stomach. This has been a hard story to tell, and frankly I’m pretty exhausted by the whole deal. I’m leaving for a week’s vacation 12 hours from now, so let me apologize in advance for not posting the links right away. I will try to get to it before I leave. If not, I’ll do it once I land. These drugs definitely have their place in our arsenal of weapons, but each individual’s history should be carefully evaluated in light of CGRP’s profound effects in the body.
1. Holly Harding Moderator & Contributor
 Hey <inline-mention user-id="3784210" username="katetyndall"/> - I'm always grateful to hear from you and deeply appreciate your level of thoughtful reflection. I must say, I have been really mulling over what you've shared here ever since reading it. I've shared it with my loved ones and we've been discussing it in depth. I think so many of us migraineurs (me included) are SO darned desperate for a solution that we eagerly inject or ingest whatever new treatments are released without asking enough questions about potential repercussions. You raise important questions that I admit to having grazed right over in my own desperation for a cure. The huge one of course being that we are all making this protein for a reason. So when we block it entirely, there may be systemic and potentially problematic repercussions (both in the short and long term). I'm grateful to you for raising such important points and have a favor/question to ask. Would you be willing to share this comment you've so carefully crafted and put it into one of our other sections on <a href='https://migraine.com?' target='_blank'>migraine.com?</a> Either the stories page or the Q&A page? I might encourage you to use the stories page (<a href='https://migraine.com/stories' target='_blank'>https://migraine.com/stories/</a>) as a means to share your experience with the treatment-- but you could instead post it in the Q&A section (<a href='https://migraine.com/q-and-a' target='_blank'>https://migraine.com/q-and-a/</a>) as a way to ask others for their input on the topic. Finally, we have a number of forums dedicated to various themes related to CGRP- you could post your experience additionally there- it's okay to put it there in addition to one of the aforementioned pages): <a href='https://migraine.com/forum/cgrps-calcitonin-gene-related-peptide' target='_blank'>https://migraine.com/forum/cgrps-calcitonin-gene-related-peptide/</a> Up to you where you put it, and of course whether or not you want to post it again at all. But, I would love to see it posted in a way that would get more eyes on this important content. Let me know if you have any questions about this or thoughts you'd like to share. Thanks again, so much, for taking the time to share such a thought-provoking post. I'm grateful you are a part of our community and appreciate learning from you.
katetyndall Member
Here are a couple of links re CGRP’s effects in the body, and questions that should be asked when considering using a monoclonal antibody to suppress CGRP’s activity: <a href='https://www.practicalpainmanagement.com/pain/headache/stake-possible-long-term-side-effects-cgrp-antagonists' target='_blank' rel='noopener noreferrer ugc'>https://www.practicalpainmanagement.com/pain/headache/stake-possible-long-term-side-effects-cgrp-antagonists</a> <a href='https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-017-0807-1' target='_blank' rel='noopener noreferrer ugc'>https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-017-0807-1</a>
deedeevee1 Member
Holly you're awesome!! I want to thank you AGAIN for doing what should be done by others in my opinion. Thanks for being there at least when I always need you!! Lol
1. deedeevee1 Member
 Haha. No forgiveness needed for forgetting the miniscule tribulations of my life. Lol. I tried Aimovig first. That was terrible too. The vertigo got so bad again. I was practically bed ridden. And I don't mean to be vulgur, but I couldn't poop to the point it was painful. And that was the first month. I soldiered thru 2 more just to make sure it was the Aimovig and nothing else. But sadly it was. 🙁 I'm not as inclined to try with the Emgality. This medication hurts going in and gives me more of a triptan feeling. So I'll just toss it in the ever-growing pile of tried and didn't work meds. 🙁
2. Holly Harding Moderator & Contributor
 <inline-mention user-id="3718603" username="deedeevee1"/> - you are SO good at your descriptions! I know EXACTLY what you mean (and I KNOW others will as well) when you say that "triptan feeling". I had not made that connection, but now that you say it, I get it- and agree. And you're right- it really burns going in. I hope they address that as they move forward. I have heard many many community members discussing extreme constipation with some of the CGRPs to the point that it has made them stop taking something that is helping with their migraines because it is causing such an extreme issue with their digestive systems. Truly feels like we can win sometimes with finding a medication that just addresses the migraine alone without causing so many other issues.
susie62 Member
I tried Emgality, hoping this would work. I had 2 severe auros. I woke up choking to paint and the next night wood.
1. Holly Harding Moderator & Contributor
 <inline-mention user-id="3865020" username="susie62"/> - Oh my goodness - that sounds very troubling. I hope you will discuss these side effects with your migraine specialist. How long ago did you take the injection?
latodavia Member
My doctor just sent me home with 2 doses of Emgality, but he recommended I not do a "loading dose" of 2 injections the first time. Has anybody used it without a loading dose, and how long did it take to start working?
1. Holly Harding Moderator & Contributor
 Hi there, Latodavia- While I've heard of some people taking the loading dose on a long term basis (two injectables every month), I haven't personally heard of starting with just one though I'm sure that's been tried. You might try checking our forum dedicated to Emgality and see if you can find anything relevant or of interest there regarding the loading dose and its overall efficacy: <a href='https://migraine.com/topic/emgality-share-experience' target='_blank'>https://migraine.com/topic/emgality-share-experience/</a>. If not, and if you're open to it, I'd encourage you to post your question on our Q&A page where more of our community members will see it and will hopefully chime in if they have relevant info to share: <a href='https://migraine.com/q-and-a' target='_blank'>https://migraine.com/q-and-a/</a> . Thanks so much for sharing- please stay in touch!
bri217 Member
Hello all, I've been using Emgality for about 6 months. Having done self injections before I have found that there are options to using this medication. The injection pens are ok and easy to use but they sting a lot! I have found that you can get this medication in a pre-filled syringe which allows the user to control the speed in which the medicine is pushed into the body. This helps so much and is virtually pain free. The needle in the pre-filled syringe is exposed and sometimes it's hard to convince your mind to stick yourself. This needle is so small that a quick motion to inject is painless. Pressing the plunger should be done slowly which is the kicker to a pain free injection. Hope this helps!
1. bri217 Member
 My doctor gave me the option of the pen or pre-filled syringe. However, in my case I also had to call the pharmacy once the prescription was received to make sure they ordered the pre-filled syringe. My pharmacy told me that the computer will default to the pen unless they specifically change it in their system. Both the pen and syringe are available to anyone upon request.
2. Holly Harding Moderator & Contributor
 bri217- Thanks so much for writing back with the information regarding how to attain the pre-filled syringes. I will be looking into this and am sure others will as well. Grateful for your guidance on this- so glad you're a part of our community. Holly (migraine.com team).
ninak Member
Thank you Holly for making the video it was very helpful! I would like to add that I just did my first injection today, so I am hopeful I have good results. I did ice both of my thighs before I did my injections based on what I had read about how much the meds stings. It seemed to make a huge difference for me. I would encourage anyone to try icing their injection site the next time and see if that helps. All the best.
1. Holly Harding Moderator & Contributor
 Hi NinaK- Thanks so much for the icing tip! Great idea. I'll try that next time. Strange how sometimes the injection stings like mad and other times I hardly feel it at all. I can never figure out why. Keep in touch and let us know how the treatment works for you. We'll be hoping for the best possible outcome. - Holly (migraine.com team).
treetops Member
Hi Holly, I gave myself my first loading dose of emgality today. I followed the recommendations re: 1. Taking it out of the fridge beforehand - it was probably out for an hour or so. 2. Using an ice pack to numb the injection site. I decided to inject in my thighs and kept the ice pack on the site for as long as I could before it started to hurt, I'd guess 4-5 minutes. It hardly hurt at all! 😀 It was also much quicker than 10 seconds. I didn't hear a first click, as described in the instructions, just the second, after about 4 or 5 seconds. I thought 'it can't be done that quickly!' and kept holding the pen down until I'd counted to 10. Then lifted it up thinking I'd mucked it up in some way! But there was the tiny point of blood and the grey plunger was visible. I felt a little odd and shaky after the first injection but that could have been just the relief of getting it done and over with. It's four hours later now and I'm doing fine. One thing I'm confused about is how to taper down the daily pain meds I take which stop the migraines from developing in the first place. The specialist initially said wait one month after the injections and then start reducing, and then said wait two. My doctor wanted me to start reducing my meds by 25% straight away, which is what I've decided to do. I've read all the comments on this site and this isn't discussed but it seems the time it takes for the emgality to work is really variable, if it works at all. Any insights are welcome.
1. treetops Member
 Hi, Finally got a chance to update my experience with Emgality. I had an intense reaction that first night with my legs getting very hot. I have this anyway as a menopause symptom but it was much worse than usual. Over the next couple of weeks I found I was getting more hot flushes and I also had a few bouts of feeling chilled. But I did have fewer migraines and was able to reduce my pain med dosage by 25%! But I have had to stop taking the Emgality, last dose was October 7, because it made me so sensitive to heat that even being in the sun for 5 minutes was enough to make me overheated which then led to extreme fatigue for 2-3 days. (This appears to be related to having glandular fever last year.) I didn't suffer from constipation which was the only recorded side effect, but I was taking massive amount so fibre to prevent it. But I did get really frequent wind, especially in the afternoon, so I was glad I qas working from home at the time! I had a look on a users forum (can't remember what it's called now) and around a third of people had issues with heat regulation. So a big shame that I had to stop using it, I may try the other CGRP blockers after I think the Emgality has fully left my system.
2. Holly Harding Moderator & Contributor
 treetops- thank you so much for circling back and telling us about your experience with Emgality. I had not heard about the potential impact on the heat regulation side of things and find that fascinating. Like you, I'm closing in on a time in life when I may begin experiencing menopause symptoms so I could imagine how it would be complicated to tease apart those side effects from one another. I'd be most interested to hear back from you if you choose to move on to another one of the CGRPs regarding how it compares and works for you. Thank you so much for sharing your experience, wisdom, guidance and insight with the rest of us. Very grateful you did so! Warmly, Holly (migraine.com team).
CommunityMember418644 Member
Thank you for the video on injecting emgality. I am a veterinary assistant so I am used to giving injections but I am a little nervous about injecting myself. 
1. Rebecca C Moderator
 <inline-mention username="CommunityMember418644" user-id="6697418"/> I can really relate to this as I have worked in the healthcare field for many years. It's one thing teaching others to inject their biologics /CGRPs and another when you've got to inject yourself. I have been very nervous in the past, but with practice and experience, it has become easier to manage. One tip I have learned from nurses/physicians in the office is to ice the area 5 mins prior to injection and it helps with the "sting" of injection. Thanks for sharing your view on injections and am so glad this video helped. Best of wellness. Light and energy sent your way this holiday season. Rebecca (comm advc)
2. Holly Harding Moderator & Contributor
 <inline-mention username="CommunityMember418644" user-id="6697418"/> So glad this video was helpful to you. Have you tried the injection yet? Curious how it went, if so. I will share that after I made this video, and now that I've continued to inject Emgality monthly, I've found it's less painful doing into my belly - it really can sting at times! And I agree, injecting oneself does take some getting used to. Thinking of you! Warmly- Holly <a href='https://-migraine.com' target='_blank' rel='noopener noreferrer ugc'>-migraine.com</a> team.
SRBrunoRPh Member
Just FYI. It may sting LESS if you allow the alcohol to dry before injecting yourself. Just wave your hand over the prepped area to dry it. Good Luck. 
1. Rebecca C Moderator
 Great tip - thank you for chiming in on this topic. How are you doing lately? Are migraines managed sufficiently? From your comment I understand you may be using a medication that is injected - how is it working for you? Is it a CGRP? Warmly Rebecca (comm advc)
2. Holly Harding Moderator & Contributor
 <inline-mention username="SRBrunoRPh" user-id="6716807"/> thanks for the tip! Do you find that one location (tummy vs thighs) is less or more painful than another? Appreciate your input! Warmly- Holly <a href='https://-migraine.com' target='_blank' rel='noopener noreferrer ugc'>-migraine.com</a> team.
CommunityMember7b15de Member
Hi my name is Cyndi, The shot is just like my Trulicity I do once a week. I have no problem with that, it will be good for me. Does it matter what day of the week you do your shot on??
1. Holly Harding Moderator & Contributor
 <inline-mention username="CommunityMember7b15de" user-id="8644256"/> - So glad you have experience with this type of injection- that should help you greatly. As to the best day of the week- I'm not sure what you mean. The injections should be given every 30 days (some people say closer to 25 days. This is something that should be discussed with your doctor). At any rate, either way, it ends up changing the day of the week due to the differing amount of days in each month. You can certainly start on whatever day you'd like. I don't have any side effects from taking this medication. Thanks for chiming in! Best of luck with this. Please let us know how it goes for you. Warmly- Holly <a href='https://-migraine.com' target='_blank' rel='noopener noreferrer ugc'>-migraine.com</a> team
Purlgurl Member
I just wanted to say, I’ve been taking the emgality pen for a year now and I saw your video the first time I was trying to figure out how to administer it on my own. It was the only thing I found that made me comfortable with the whole process and understand clearly how to do it. I revisit it each month whenever it’s time for another dose and watch it 2-4 times just to calm myself. I feel like I could definitely recite the video from memory by now but I rewatch it every time anyways because it makes me feel like I’m not alone and can handle this. Thank you so much for making this video
1. Purlgurl Member
 I inject it in my thigh every time because no matter how much I try to rationalize with myself that it’s a subcutaneous injection, I can’t bring myself to do it into my abdomen. I even just tried my left thigh instead of my usual right thigh one time when it was super bruised, and I ended up with a matching bruise on the left side from the injection site! I think it was likely because I’m right handed and couldn’t steady it as easily.
2. Holly Harding Moderator & Contributor
 <inline-mention username="Purlgurl" user-id="8674107"/> - That's interesting and resonates with me as well. Once you get used to one place, moving from there can be hard. Before I got used to injecting myself, I would sit for 30 minutes to an hour to muster my courage. Now I'm much easier with it, but it would feel like starting over if I had to move to a different location. And yes, it really does matter if we are left or right-handed. The bruising factor is one I still can't figure out. Some months I have no issue while others I bruise. It could be a matter of being steady, as you say. Do you have a difficult time with it stinging? Like bruising, I can't figure out why some months are more painful than others. Thanks so much for sharing your thoughts and wisdom on this front! Stay in touch. Warmly- Holly <a href='https://-migraine.com' target='_blank' rel='noopener noreferrer ugc'>-migraine.com</a> team
Bee_fonzy Member
I've been on emgality for approximately 1.5 years now. I have used tummy and thighs as injection sites, auto injection and pre-filled self injection. The past 6 months of use have been strange, injection sites get really swollen and hot for 4 or so days, and have gained a significant amount of weight. Last month I froze trying to give my injection, had to have help. This months was a misfire it clicked but the pen malfunctioned and didn't fully click all the way. I'm currently waiting on the Dr to okay the urgent refill. I have only had maybe 5 migraines in my time of using Emgality which has been wonderful after having them since the start of puberty and then increased at age 20 when I started having seizures. But in the back of my head the I feel that I may need to stop the medication with the sudden issues that have occurred. 
1. Holly Harding Moderator & Contributor
 Hi <inline-mention username="Bee_fonzy" user-id="8678681"/> - I'm so sorry to hear you are encountering troubles related to the Emgality injection especially because it's working so well for you as a preventative. We frequently hear that the CGRPs seem to lose efficacy over time- and glad this is not the case for you. However, the growing challenges related to the injection itself sound very troublesome. And yes, as the bad experiences with injections culminate, it becomes more and more difficult to do the injections! This article speaks to some of the side effects of Emgality and make mention of soreness and redness at the injection site: <a href='https://migraine.com/emgality-galcanezumab-gnlm' target='_blank'>https://migraine.com/emgality-galcanezumab-gnlm</a>. The weight gain so far in to your time with Emgality is interesting. Have you discussed the injection issues or weight gain with your doctor? I would think s/he could either put your mind at ease or encourage the trial of a different CGRP if the issues are significantly concerning. Thankfully there are a lot of different CGRP treatments available now - some are given by pill, others by IV. You might ask your doctor about Nurtec, Ubrevely, and Quilipta (all pill form). They are slightly different in nature from the CGRPs and known as Gepants. Still, same family as CGRPs, so since Emgality has worked so well for you, hopefully another will as well. If you'd like to learn more about any of those options, you can find more here: https://migraine.com/cgrp-new-direction-migraine-treatment. Please know we are here for you and glad you are with us. Keep in touch and let us know what you decide to do. Warmly- Holly <a href='https://-migraine.com' target='_blank' rel='noopener noreferrer ugc'>-migraine.com</a> team
Amber dawn Member
I've been using emgality for a few years now. I'm not afraid of needles. Not in any way. I had my ribs tattooed for 4 hours and napped through the whole thing. The emgality shot is a whole other story. I needed my shot yesterday and it's still sitting there in the box. I go through this every single month. That needle feels like a damn penny nail and the medicine feels like syrup. This stupid shot is the most painful thing I've felt. Want to talk about hairloss?? I've lost about 50% of my fine red hair. After a couple of years, I think I won't be doing this mess anymore. I want my hair back and to stop the ridiculous pain and anxiety I'm putting myself through and I'll suffer through the horrible migraines. I can't do this mess anymore. 
1. Holly Harding Moderator & Contributor
 <inline-mention username="Amber dawn" user-id="9768455"/> HI dear- I'm SO sorry to hear about this nightmare related to the emgality injection. I'm surprised you've been able to keep up with it for a few years given how painful it's been for you. The video (above) is actually me - and I grew to the point that it got more painful with time. That's not why I stopped using it, however. I stopped because it was too expensive for me to maintain. I recently switched over to Qulipta (a pill) and have found it works just as well and maybe better. I didn't experience hair loss with the emgality, however. We all are so different in terms of the side effects from the CGRPs (and really any medications). I share this because I'm not sure it has to be either you continue with the anxiety and pain OR you suffer horrid migraine attacks. As now there are a lot of alternatives these days on the CGRP list. And many are given in pill form. One, Vyepti, is a monthly infusion. Do you feel good about your doctor? Perhaps you could discuss these alternatives at your next appointment: <a href='https://migraine.com/clinical/cgrp-gepants' target='_blank'>https://migraine.com/clinical/cgrp-gepants</a> and: <a href='https://migraine.com/migraine-treatment/preventive' target='_blank'>https://migraine.com/migraine-treatment/preventive</a>. Let me know what questions or concerns you have - we are here to provide you with support and information anytime. So glad you reached out! Hopefully you will not have to continue between this rock and hard place! thinking of you- Warmly - Holly (team member)