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Vyepti:  Evidence-based Treatment for Migraines

By July 22, 2022Blog



If you have ever experienced a migraine, there’s no denying the debilitating pain one feels in their eyes, face, or head.  Migraines can last for days and even once the pain subsides, the aftermath of a migraine can cause severe side effects.  A migraine hangover, also called postdrome, is the last stage of a migraine. It can linger a few hours to more than a day after the headache goes away. Postdromes don’t always come, but experts believe that they happen up to 80% of the time. There’s also no way to know how intense your postdrome will be until it’s happening.  Sort of hard to plan around that, isn’t it?


The cause of migraines is not definitively known, however they are distinctly different than your “average headache”.  Migraines can cause ocular discomfort, pounding pain in the head and face, nausea and even vomiting, sensitivity to light, movement, and sound.  Although a direct cause is still a mystery, migraines are thought to be the result of abnormal brain activity temporarily affecting nerve signals, chemicals, and blood vessels in the brain.




Migraines, which affect children and teenagers as well as adults, can progress through several stages: prodrome, aura, attack. and postdrome. Not everyone who has migraines goes through all stages, however migraines greatly impact a person’s quality of life and can stop you in your tracks when it comes to daily routines or special activities you have planned.  Migraine can cause you to stay in bed for days and to feel powerless about “getting up and going” – it’s a real downer!



There are all sorts of home remedies for relieving migraine pain such as hot packs and heating pads, which can relax tense muscles. Taking warm showers or baths may have a similar effect.  Sometimes a caffeinated drink in the preliminary stages can help.  Caffeine combined with other analgesics such as acetaminophen can reduce migraine pain.


Your primary care physician or neurologist may recommend anything from over-the-counter drugs as listed above to cold compresses and caffeine.  But let’s face it, once a migraine presents itself, it can be hard to ameliorate the pain with non-prescription selections at the pharmacy.  For prescription options, some patients are prescribed sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt, Maxalt-MLT) which are used to treat migraine because they block pain pathways in the brain. Taken as pills, shots, or nasal sprays, they can relieve many symptoms of migraine.  But what happens when nothing is helping?  What happens when you’ve tried everything and still experience debilitating migraines?



Vyepti (eptinezumab-jjmr) is a calcitonin gene-related peptide (CGRP) antagonist indicated for the preventive treatment of migraines in adults.  Vyepti is given as an infusion every 3 months.  We’re pleased to offer this treatment at Acute Pain Therapies, where VYEPTI is administered under the supervision of one of our physicians at a dosage of 100 mg by IV infusion every 3 months. Some patients may benefit from a dosage of 300 mg administered by IV infusion every 3 months; it depends on the severity and frequency of the migraines and responsiveness to the 100mg dose.   The infusion runs for about 30 minutes and can begin to work immediately in some. We often include in the infusion other medications that help with headache acutely. Total office visit time may approximately 90 minutes (30 minutes preparation, 30 minute infusion, 30 minute monitoring and recovery).


Insurance generally will cover this treatment as long as the patient has tried several other classes with no success.  VYEPTI can be costly, and that’s why insurance companies will sometimes deny the treatment or take weeks to prior authorize treatment.  The best course of action ahead of a consultation for consideration of Vyepti is to gather all the records you have pertaining to past migraine treatments including any and all medications. Sometimes pharmacies can be the best resource as they have all records of any medications you have ever tried. Bringing this to consultation will expedite our ability to authorize the procedure with your insurance company.


If interested, please contact our clinic to request a consultation. In some cases we will request a referral from your primary care doctor or neurologist.

Acute Pain Therapies

Our Mission is to offer the most safe, effective and scientifically proven acute and chronic pain solutions available. Our hope with the pain management strategies we offer is to provide a means for a patient to overcome their pain while devising a way to achieve an improved quality of life of their own making, while trying to minimize the risk of becoming addicted to pain medications.