Managing Migraine: Medication Overuse Headache and Treatment with Eptinezumab

Medication overuse headache (MOH) places both a physical and emotional burden on patients. 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. 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. 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. Eptinezumab provides an additional therapeutic modality for patients who are refractory to other migraine medications, including other CGRP pathway monoclonal antibody (mAb) therapies. 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. 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.