When you have a migraine, you want it to stop -- quickly. Infusion therapy is a faster way to treat migraine than pills because it delivers the medicine right into your bloodstream.
Some migraine medicines you need to get by infusion. Monoclonal antibodies are made from proteins that would break down in your stomach if you took them as a pill.
Not everyone who gets migraine needs infusion therapy. This treatment is for more severe headaches that don't improve with over-the-counter or prescription migraine medicines you take at home. It can also be used for headaches that keep coming back despite trying other prescription medicines. It is also a way to deliver a preventive medicine when migraines keep coming on despite using other prescription medicines. But not everyone can take this treatment because certain infusions aren't safe for some groups of people.
Types of Infusion Therapy
Infusion therapy for migraine comes in a few different forms:
Dihydroergotamine, or DHE, is a treatment for migraine. It blocks the release of substances in your brain that trigger these headaches.
Eptinezumab-jjmr (Vyepti) is a monoclonal antibody that prevents migraine attacks. It blocks a protein called calcitonin gene-related peptide (CGRP) that causes inflammation and pain during a migraine attack.
Migraine "cocktails" are infusions you get at a hospital during a migraine attack. They contain different combinations of medicines, such as:
- A nonsteroidal anti-inflammatory drug (NSAID) like ketorolac to relieve pain
- Magnesium
- Medicine such as metoclopramide (Reglan) to prevent nausea or vomiting
- Diphenhydramine (Benadryl) to prevent side effects from Reglan
- DHE
- Fluids to hydrate you
When to Try Infusion Therapy
DHE may be an option if you have a migraine that lasts for more than a few days. Doctors sometimes call these long-lasting migraines "status migrainosus." DHE not only stops a migraine, but it may also prevent you from getting another one of these headaches for a few months.
You may be a good fit for DHE if you:
- Have severe or long-lasting migraine headaches that affect your daily life
- Wake up in the morning with migraine
- Get these headaches when you have your period
- Have tried triptans or other migraine treatments but they don't work or they have stopped working
- Have a migraine that's lasted for more than a few days
Vyepti may be an option for you if:
- You often get severe migraine attacks.
- Other treatments haven't prevented your headaches.
- You take migraine medicine so often that you get rebound headaches.
A migraine cocktail is a treatment you might get if you go to the hospital with a severe migraine. It's an option for a migraine that:
- Hasn't gotten better with your usual migraine medicines
- Has lasted for more than 3 days
Who Shouldn't Use Infusion Therapy?
DHE may not be safe for you to take if you have certain types of heart disease or uncontrolled high blood pressure. This medicine narrows blood vessels in your heart and brain, which could increase your risk for a stroke or heart attack.
DHE is also not safe to use during pregnancy. And it doesn't treat hemiplegic migraine, a rare type of headache that causes weakness on one side of the body.
Some medicines don't mix well with DHE. Don't take DHE if you took a triptan migraine medicine within the last 24 hours. Also don't take DHE with these medicines because they could interact and cause problems:
- Antifungal medicines such as itraconazole (Sporanox) and ketoconazole (Nizoral)
- HIV medicines like indinavir (Crixivan), nelfinavir (Viracept), and ritonavir (Norvir)
- Macrolide antibiotics, which include azithromycin (Zithromax), clarithromycin (Biaxin) and erythromycin (Erythrocin)
- Some antidepressants including SSRIs such as citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft)
Don't take Vyepti if you are allergic to any of the ingredients in it. Vyepti is safe to take for people with heart disease, liver disease, and kidney disease. This medicine shouldn't interact with any other drugs you take.
Researchers don't know whether Vyepti is safe to use during pregnancy or while breastfeeding. If you are pregnant or nursing, ask your doctor whether it's OK for you to take this medicine.
A migraine drug cocktail contains a few different medicines. Your treatment team at the hospital will make sure you don't have any allergies or problems with the medicines in it before they give you a drug cocktail.
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
American Headache Society: "Breaking News: Eptinezumab-jjmr (Vyepti) Approved by FDA."
American Migraine Foundation: "Dihydroergotamine (DHE) for Migraine Treatment," "Hemiplegic Migraine: Symptoms and Treatments," "Migraine Cocktails: What They Are and Why They Are Misunderstood."
Barrow Neurological Institute: "Dihydroergotamine Infusion Overview."
FDA: "Highlights of Prescribing Information: Vyepti."
Headache: The Journal of Head and Face Pain: "Dihydroergotamine (DHE) — Then and Now: A Narrative Review."
Health Psychology Research: "Eptinezumab-jjmr, a Humanized Monoclonal Specific to Calcitonin Gene Related Peptide, for the Preventive Treatment of Migraine in Adults."
