The Closet Professor

Yesterday, just as I was stepping into the shower, I saw a migraine aura. People who deal with migraine aura experience visual, sensory or motor disturbances just before a migraine attack. This phenomenon usually lasts an hour or less, and symptoms may range from seeing sparks and zigzags to the inability to speak clearly. For me, it is mostly the sparks that I see, and it usually lasts just a few minutes. I don’t always see an aura before a migraine, but a migraine always begins sometime in the next twenty-four hours after the aura appears. 
When I was younger, the migraine began almost exactly 

When I was younger, the migraine began almost exactly twenty-four hours after I saw an aura. In the last few years, I normally have about thirty minutes to an hour before the migraine sets in. Yesterday’s was a slow progression. It started out mild, so I went to work and tried to work most of the day with my office lights off, but by mid afternoon, that wasn’t working for me anymore. The pain was intensifying and continued to get worse over the course of the evening. Eventually, I just went to bed.

Yesterday, I had an appointment at the Headache Clinic at Dartmouth. I discussed with my neurologist how this last round of Botox did not seem like it was effective at all. I knew there would come a point when Botox would no longer work, but I expected it to be years down the road, but since I had that abscessed tooth that triggered my trigeminal neuralgia, it hasn’t been able to be as effective as it was when I had the first treatments. My neurologist said that sometimes they have to do a reset on the Botox, i.e. step away from it for a few months and try something different, possibly going back to it in the future. She told me a long time ago that migraine treatments are a lot of trial and error.

For now, she increased the dosage of one of my medicines, and she wants me to try a new treatment called Vyepti. It is CGRP drug along the lines of Emgality or Aimovig, both of which I’ve tried. Emgality was moderately effective and cut my migraine days in half, but my neurologist didn’t think that was effective enough since I basically have daily migraines. When I tried the Aimovig, not only did it not prevent a single migraine, but the side effects were awful. Vyepti is similar to Emgality but not Aimovig. Also, Vyepti has been proven more effective in people who had moderate success with Emgality, plus it has relatively few side effects.

There’s two drawbacks: the method of delivery and expense. The drug can only be given through an IV, which takes about an hour, and it must be done at the hospital. Around here, that can only be done at Dartmouth. While the drug manufacturer has a cost savings program, it’s only for the medicine, not the cost of administering the medication. The Botox cost saving program reimbursed me for all costs associated with the Botox and its administration, which together is over $6600 before insurance. Furthermore, my insurance doesn’t cover this new treatment, but I’m sure they will after my neurologist appeals it. My insurance company denies everything, but Dartmouth has always been successful in their appeals.

The first administration of this new treatment is scheduled for August 1. *Fingers crossed* it works. I’ll let you know.