Eptinezumab for Intractable Migraine with Status Migrainosus

Patient Clinical Presentation

• The patient presents with intractable migraine with status migrainosus, experiencing daily headaches, with symptoms including throbbing headache quality, whole cranial pain, marked photophobia, phonophobia, and nausea 1, 2
• The patient has failed multiple treatment options, including gabapentin, nortriptyline, Nurtec, and Ubrelvy, as well as multiple injectable CGRP antagonists 3, 4, 5

Medical Necessity Assessment

Criteria for Preventive Migraine Treatment

• Preventive treatment is indicated when patients are adversely affected by migraine on ≥2 days per month despite optimized acute treatment 4
• The patient meets criteria for chronic migraine with headaches on ≥15 days/month for >3 months and at least 8 days/month meeting migraine criteria 1

Failed Prior Therapies

• The patient has failed first-line preventive medications, including oral CGRP antagonists and multiple injectable CGRP antagonists 3, 4, 5, 6
• The patient has failed second-line medications, including amitriptyline/nortriptyline due to side effects 5

Standard of Care Assessment

• Current guidelines recommend CGRP monoclonal antibodies as third-line medications for migraine prevention after failure of first and second-line options 4, 5
• The American College of Physicians recommends considering preventive medications when episodic migraine occurs frequently or when treatment does not provide adequate response 3, 6
• For status migrainosus specifically, systemic therapy is the treatment of choice, according to Praxis Medical Insights 7