A plain-language guide to what migraine is, how preventive treatment differs from treating an attack, and what an infusion appointment actually looks like. Written for patients and caregivers in Maryland.
Migraine is a neurological disease, not a bad headache. When attacks come often enough, treatment shifts from stopping each one to preventing the next, and the American Headache Society now considers a class of medications called CGRP therapies a first-line option for that. One of them is given by IV infusion every three months. Four visits a year is the whole schedule. Springside administers it in Columbia, Bowie, and Frederick, Maryland. Your neurologist keeps managing your care. We handle the infusion, the insurance authorization, and the paperwork.
Migraine is a neurological disease. The pain is the part people talk about, but an attack involves changes across the nervous system, which is why it comes with nausea, light and sound sensitivity, and a fog that can outlast the headache by a day.
If you have spent years being told to take something and lie down, that is worth saying plainly. Migraine is a diagnosis, not a description of a bad day. It has a course, it can get worse without treatment, and there are medications built specifically for it.
The distinction that matters most for treatment is how many days a month you are affected.
That threshold is not a label for how much you are suffering. It is a clinical line that changes which treatments your doctor will consider, and it is one of the reasons keeping a record of your headache days is worth the trouble.
An attack is not one event. Many people can feel it building before the pain starts and are still recovering after it stops.
The parts that are not pain are often the parts that cost you the day. That is worth telling your doctor about, because it changes how the disease is measured and treated.
This page is educational, not medical advice. Only your doctor can diagnose migraine or decide which treatment is right for you. If you have a sudden severe headache unlike any you have had before, a headache with fever, confusion, weakness, or vision loss, or a headache after a head injury, seek care right away.
Migraine treatment runs on two tracks, and they do different jobs.
Acute treatment stops an attack that has already started. Taken at the first sign, as needed.
Preventive treatment is taken on a schedule whether or not you have an attack. The goal is fewer attacks, less severe ones, and a better response to your acute medication when an attack does come. Preventives are usually considered when attacks are frequent, disabling, or when acute medication is being used often enough to cause problems of its own.
What we give is preventive. It reduces how often attacks happen. It will not stop the one you are having today, and it is not a rescue treatment. If you are in an attack right now, the person to call is your doctor.
CGRP stands for calcitonin gene-related peptide. Per the Vyepti label, the medication "binds to calcitonin gene-related peptide (CGRP) ligand and blocks its binding to the receptor." In plainer terms, CGRP is a protein involved in migraine attacks, and the drug takes it out of circulation before it can act.
This matters because of what came before. For decades the preventive options were medications developed for something else entirely and borrowed for migraine: blood pressure drugs, antidepressants, anti-seizure medications. The CGRP treatments are the first preventives designed for migraine from the start.
That difference shows up in how people get on with them. In 2024 the American Headache Society moved CGRP therapies to first-line, stating that "the efficacy and tolerability of CGRP-targeting therapies are equal to or greater than those of previous first-line therapies" and that "a consistent finding across all the studies of CGRP-targeting therapies for migraine prevention has been a very low drop-out rate." Of the older medications, the same statement says "adherence to these therapies is poor, based in part on unsatisfactory tolerability, and, in part, on lack of efficacy."
If you tried a preventive years ago and stopped because of how it made you feel, that is a common story, and this is not that medication.
The same statement makes a point about timing that is worth knowing: "there is evidence that suggests that a delay in effective preventive treatment may result in the disorder becoming more refractory." Waiting has a cost.
Preventive. Given as an IV infusion. Eptinezumab (Vyepti).
Per its FDA label, Vyepti is "indicated for the preventive treatment of migraine in adults." The recommended dosage is 100 mg by intravenous infusion every 3 months, and the label notes that "some patients may benefit from a dosage of 300 mg." It is infused over approximately 30 minutes.
Not every migraine preventive is an infusion. Several CGRP medications are self-administered injections taken at home monthly, and there are CGRP tablets as well. Which one is right for you is a conversation with your neurologist.
A lot of people who would benefit from preventive treatment have never been offered it. Often that is because the conversation never turned to how many days a month they were actually losing.
Here is the thing worth knowing: the question is not how bad each attack is, it is how many days a month you have one. Someone with four moderate attacks a month may be a stronger candidate for prevention than someone with one severe attack. The threshold that defines chronic migraine, 15 or more headache days a month for more than three months, is a clinical line, and there is a great deal of room below it where prevention is still the right call.
A count. Not a description, a count. How many days in the last month did you have a headache, how many of those stopped you doing something, and how often did you take an acute medication. A month of that written down changes the conversation with your doctor more than anything else you can do.
If you have never had an infusion, or you have only had one in a hospital, here is the shape of a typical visit. This is a short appointment. Compared with the biologic infusions we give for other conditions, which can run several hours, this is about half an hour of infusion time.
Plan for more than the infusion time. The 30 minutes comes from the FDA label and covers the infusion itself. Check-in, IV placement, and any observation are on top of that. When we confirm your appointment, we will tell you how long to plan for.
You can change where you receive your infusions without changing your neurologist. Your neurologist continues to manage your migraine and writes the order. We administer the medication and report back to them.
Many Maryland insurance plans now prefer, and some require, that non-urgent infusions be given at an ambulatory infusion center rather than a hospital outpatient department. That is often at meaningfully lower out-of-pocket cost. Coverage rules and prior-authorization requirements vary by plan, so we verify your benefits and handle the authorization before your first visit.
