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It is also useful in providing therapeutic cover in opioid-overuse medication overuse headache patients who are unable to attend in-patient detoxification.įrom a practical perspective, I have found that eptinezumab is straightforward to administer intravenously in our headache clinic infusion facility. Intravenous eptinezumab achieves rapid therapeutic levels, and a rapid onset of effect (typically within 1 day following administration). Eptinezumab provides an additional therapeutic modality for patients who are refractory to other migraine medications, including other CGRP pathway mAb therapies. In some patients, intravenous eptinezumab at 12-week intervals is preferred to self-administered subcutaneous CGRP pathway mAb options. Patients who have failed two to three prophylactic medications should be referred to a neurologist with experience in headache management. A fourth CGRP pathway mAb therapy, erenumab, is available on private prescription. Two other CGRP pathway monoclonal antibody (mAb) therapies (fremanezumab and galcanezumab) are reimbursed by the Australian government for eligible patients. At the time of publication, eptinezumab is available to Australians by private prescription, however an application for government reimbursement has been submitted and government reimbursement is expected in the near future. In Australia, eptinezumab is indicated for migraine prophylaxis in adult patients. Elevated blood levels of CGRP can also trigger migraine. CGRP is found in neurons in the trigeminal ganglia in the brain and is released during migraine attacks. ICHD International Classification of Headache Disorders, MOH medication overuse headacheĮptinezumab, a humanized monoclonal immunoglobulin G1 (IgG1), selectively inhibits both the α and β forms of the human calcitonin gene-related peptide (CGRP) ligand. It is important to tailor treatment plans to the individual patient needs and provide other lifestyle and non-drug-based recommendations when treating patients with MOH, who may be appropriate for treatment with eptinezumab. I discuss within this article the potential role for eptinezumab in various clinical scenarios such as refractory migraine, including MOH, in which the rapid bioavailability of the preparation may be of particular utility. Eptinezumab provides an additional therapeutic modality for patients who are refractory to other migraine medications, including other CGRP pathway monoclonal antibody (mAb) therapies.

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In this article I present a series of clinical scenarios in which the use of eptinezumab may be beneficial, based on the extensive experience I have gained using the treatment, in more than 25 patients, (and over 40 infusions), over a 2-year period. Despite acute and prophylactic treatment options, there remains a complex subset of patients who fail first-line oral prophylactic therapies due to insufficient response or failure to tolerate, and require access to new prophylactic treatment options, including calcitonin gene-related peptide (CGRP) inhibitors such as eptinezumab.

MOH may occur as a consequence of a negative spiral of events comprising an increasing number of headache days while taking frequent or excessive amounts of medications for acute treatment of headaches or migraine. Medication overuse headache (MOH) places both a physical and emotional burden on patients.

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