According to some estimates, as many as 39 million Americans live with migraine, a common neurological disease causing symptoms like light and noise sensitivity, head pain, nausea, vomiting, fatigue, and dizziness. Almost 1.2 million annual emergency room visits involve migraine attacks, making the condition the sixth most disabling in the world.
If you live with migraine, you likely already know how much symptoms can interfere with your life. Most people with migraine are unable to perform daily activities during an episode. For many, migraine attacks happen occasionally; others experience them all too often. You may receive a diagnosis of episodic migraine if you have fewer than 14 migraine days each month. And you might have chronic migraine if you experience more than 15 migraine days a month. Either way, migraine makes living a normal life very difficult.
Fortunately, migraine prevention medications can effectively cut down on migraine attacks and bring relief. Your doctor may prescribe medications initially developed to treat other non-migraine conditions, like anticonvulsants or beta blockers. Or you may try newer therapies, called CGRP inhibitors, which target pathways in your brain that can trigger and worsen migraine attacks. CGRP inhibitors can be delivered in different ways. Injectable drugs in this class include erenumab (Aimovig) and galcanezumab (Emgality). CGRP inhibitors taken orally include rimegepant (Nurtec ODT) and atogepant (Qulipta). At this point, only one of these drugs is given intravenously (IV): eptinezumab (Vyepti). This medication is administered once every three months and has been shown to be highly effective in preventing migraine attacks in different studies. It’s the first of its kind, but more IV therapies to prevent migraine are being studied and coming down the pipeline soon.
If IV treatment for migraine is right for you, you should know what to expect. Most infusion therapies are performed as outpatient procedures, meaning you’ll be able to go home the same day as your treatment.
Before your first treatment, be sure to have your paperwork completed. Sign any consent forms and provide your insurance information to the clinic ahead of time. You’ll also need to let your doctor and the infusion center know what other medications you’re on to prevent any possible drug interactions.
Most infusion centers focus on the comfort of the people they treat each day. Many centers provide amenities like free wifi, relaxing recliners, televisions, reading materials, and complementary coffee and snacks. However, you can probably also bring things from home to help you feel comfortable. Be sure to check with the infusion center to see if you can bring items like pillows, blankets, headphones, tablets, and other items. If you’re uncomfortable with needles, talk to your healthcare provider about your concerns and they may be able to make it an easier experience for you.
Depending on your treatment plan, IV therapy with eptinezumab may take up to an hour at a time. It’s very likely you’ll need to stay at the infusion center after your treatment for a few hours, just to make sure you don’t experience any side effects.
If you’re thinking of trying IV therapy to prevent migraine attacks, you probably want to know how likely it is that it will alleviate your migraine burden. The clinical trials that reviewed eptinezumab’s efficacy showed positive results for many people. In the first study looking at eptinezumab, researchers divided patients into two groups. One received various intravenous (IV) doses of eptinezumab over a period of 36 weeks. The second group received a placebo, or treatment with no actual benefit, over the same time period.
Out of the 888 people who received at least one dose of eptinezumab, most reported a 50 to 75% reduction in monthly migraine days compared to those who received the placebo. The most common side effects of the new drug were nausea and fatigue.
The second study went on to investigate the effects of eptinezumab in people living with chronic migraine. Over 24 weeks, 706 adults received treatment with the new drug while 366 received a placebo.
After just one dose of eptinezumab, people with chronic migraine saw a dramatic reduction in monthly migraine days. This was further decreased after a second dose of the new drug was given. As many as 19.4% of people reported a 100% improvement in monthly migraines.
The main side effects reported in this trial included nausea, upper respiratory tract infections, nasopharyngitis (inflammation of the nasal cavities and pharynx), and migraine.
As a result of these studies, the U.S. Food and Drug Administration (FDA) approved eptinezumab for the preventative treatment of migraine in adults.
Receiving migraine prevention medication via infusion can be a convenient way to control migraine, since you’ll only need to have it administered four times a year. It can offer relief to many people, but it’s not right for everyone. Be sure to talk with your doctor to decide whether it could be a good choice for you.