IV Therapy for Chronic Migraine

Infusion therapy for chronic migraine means getting intravenous (IV) medications. This treatment can break migraine cycles that refuse to go away. It may also be an option for preventive treatment.

Infusion therapy, also known as intravenous (IV) therapy, delivers medications through a vein. Because it goes into a vein, a healthcare professional usually administers it. Knowing what to expect during this process can help ease anxiety and prepare you for the treatment.

There are two main reasons for using IV medications for migraine. The first is for treating a migraine headache and its complications in the emergency room (ER), as migraine headaches are a common reason people visit the ER. Also, a person might be admitted to the hospital to receive medication for severe migraine headache treatment.

These can include:

• Refractory chronic migraine​: This is migraine that has not responded to standard treatments, such as oral nonsteroidal anti-inflammatory drugs (NSAIDs) or triptans.
• Status migrainosus​: This is a debilitating migraine attack lasting more than 72 hours.

IV medications are very useful for these emergencies because they go right into the bloodstream. This means they can work very fast to relieve severe or refractory migraine episodes. They can also work when you cannot take oral medications due to nausea or vomiting. These symptoms are common with severe or refractory migraine.

The other main reason for using IV medications is to prevent headache episodes in people with chronic migraine.

Chronic migraine means having headaches on 15 or more days per month for more than 3 months. And other migraine symptoms need to be present on at least 8 of those days. For these people, there’s an IV medication that can help prevent these frequent migraine attacks.

Common medications used in the ER to treat migraine headaches include:

• Dihydroergotamine (DHE)​: works by tightening blood vessels (vasoconstriction)
• Ketorolac: an IV NSAID
• Magnesium sulfate: a second-line treatment because study results on its effectiveness have been mixed
• Metoclopramide or prochlorperazine: anti-nausea medications
• Valproate (Depacon)​: a second-line treatment with mixed results for its effectiveness 

The Food and Drug Administration (FDA) has approved a preventive drug named eptinezumab (Vyepti) for long-term migraine treatment.

For eptinezumab, you visit your doctor’s office every 3 months for an IV dose that blocks the CGRP protein, which can cause migraine headaches. To learn more about this preventive option as you consider your treatment goals, talk with your doctor to understand the benefits and establish the next steps.

All IV medications for migraine are given by a healthcare professional in a clinical setting. This could be during a hospital admission or a visit to the ER, clinic, or doctor’s office.

How long the infusion will take depends on the specific drug you’re getting.

When you get an IV infusion for migraine, there are some common steps you can expect.

Before you get the infusion, healthcare professionals will need to get everything set up. This usually includes:

• conducting a medical assessment of your vital signs and general well-being
• reviewing the possible side effects that could happen, including what symptoms you should report to them during the infusion
• placing an IV line into a vein

During the infusion, healthcare professionals will have duties to perform, including:

• continuing to monitor your vital signs and well-being
• giving additional medications to manage side effects if necessary
• maintaining a controlled environment that allows you to rest as much as possible

Many people with chronic migraine report significant benefits from IV infusion therapy. Most people feel relief very quickly with the first-line treatments of IV ketorolac or DHE. The effects of these drugs on migraine pain may last from days to weeks after the infusion.

For the preventive infusion with eptinezumab (Vyepti), its effects can last up to 3 months.

Common side effects vary by medication, but there are some risks with any IV medication. This includes the risk of infection, vein irritation, pain, or other reactions at the injection site.

Examples of specific side effects from IV migraine medications may include:

• DHE​: nausea or vomiting
• Eptinezumab (Vyepti): nasal congestion, sore throat, and possible allergic reactions
• Ketorolac: digestive system problems and kidney problems
• Magnesium sulfate: low blood pressure
• Metoclopramide or prochlorperazine: akathisia, which is a movement problem that makes you feel like you cannot be still
• Valproate (Depacon)​: nausea or vomiting and muscle weakness

Infusion therapy with IV medications is a possible treatment option for certain people with migraine headaches. This treatment can help people who need immediate pain relief in an ER. It also has a role in preventing migraine headaches. Talk with your doctor to learn if IV infusion therapy is right for you.