I have not tried Vyepti as of yet. A little "concerned" since it is IV and so invasive...plus I am sensitive to any new medications. But having said that - it very well might be my next "go-to" in my awful migraine journey.
Since I have heart disease I can not use any of the triptans. A bummer for sure since I believe this class of drugs are the 1st line of defense in migraine control & most effective.
So only CGRPs for me.
I have tried Ubrevly, Emgality (for prevention, worked for about 3 months), Nurtec (prevention and abort) and Qulipta for prevention. All the CGRPs cause constipation but Qulipta brought it to a new level and I had to stop it for this reason. Bottom line - none of them really gave me complete relief...perhaps "a little" but nothing outstanding. Botox has been suggested to me but I have a fear of my face becoming "paralyzed" from it...perhaps unreasonable but that's me.
Reyvow also suggested but it can raise blood pressure so it might not be for me. Would be interested if anyone tried it. My neurologist is now saying I have "refractory" migraines. Great.
Never had them until a concussion in 2019 and a thunderclap headache in 2020. I am 69 years old and a retired RN. I did purchase a neuromodulating device - Nerivio for prevention and abort. I believe it was effective for about 5 months in reducing the # of migraines per month. But then I got lazy and stopped using it 3x week as recommended. I must go back to it again...it's a 45 minute treatment - maybe that's why I stopped. I didn't feel like sitting that long with it. But like everything I tried, eventually it was not that effective. Acupuncture didn't work for me. And I am already on a beta blocker for my heart condition. Topamax gave me massive brain fog to the point I couldn't even function. I would "forget" what I was doing and why.
So what do I do with my migraines? I have my migraine ice cap which does help...my migraine indoor sunglasses to cut down on glare. And always a nap. Stress is my # 1 trigger so I try to meditate. I also go to the spa monthly for "headache massages". Expensive for sure but I consider this a "medical" procedure. I have walked into the spa with a brewing migraine and by the time my massage therapist is done - the migraine is alleviated. I also do guided imagery and listen to relaxation CD tapes for stress management. My CD player is 25+ years old 🙂
And, I believe a biggie - I do chair yoga (can't get up off the floor)...again, I can have a migraine in progress and after my session, it is gone. So that's my story. I wouldn't wish migraines on my worst enemy if I had one. And such a stigma attached to migraines. Most people think you are "just" having a headache. They don't understand migraine is a neurological health condition.
And frankly I have come across some folks who think you are being "dramatic" when you say "I can't do that, I am having a migraine right now".
As Francine said - thank you for any feedback. briarrose

It took several week Ubrelvy to work Nurtec worked rightway. Vyepti worked for me after several weeks. That being said you have to follow food restrictions, start salting your food more.
Chiropractors, beta blockers, triptans, and acupuncture are a waste of time. You should if not you should see a Migraine specialist.

There are plenty of foods, fake sugars, nuts ects I cannot eat or drink.