Neurology · London
Vyepti (eptinezumab) IV for chronic migraine, by a consultant headache neurologist.
A NICE-approved (TA871) quarterly IV CGRP monoclonal antibody for chronic migraine that has failed at least three prior prophylactics - arranged with a specialist headache neurologist, in a proper day-case unit.
Indicative pricing
What a private course of Vyepti costs in London.
Indicative ranges across UK headache clinics.
In short
£900–£1,500, home the same day.
| Treatment | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| Vyepti (eptinezumab) 100 mg infusion | £900–£1,500 | 60–90 min | Same visit |
| Vyepti 300 mg infusion (higher dose) | £1,800–£2,800 | 60–90 min | Same visit |
| Annual course (4 infusions, 100 mg) | £3,600–£6,000 | Quarterly | Per cycle |
| Headache neurology consultation | £280–£450 | 45–60 min | Same visit |
| Follow-up review (12–24 weeks) | £180–£320 | 30 min | Same visit |
| Botox PREEMPT (alternative pathway) | £600–£1,200 | 30 min | Every 12 weeks |
Prices vary by clinic, by the neurologist leading the case, and by the dose agreed. NHS funding is available where NICE TA871 eligibility is met at a specialist neurology service - a neurologist can confirm which route fits.
The problem
The right patient, the right agent, the right monitoring.
A CGRP monoclonal is one of the most consequential decisions in migraine care - and one of the easiest to get wrong.
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Is Vyepti really the right agent?
IV every three months is one option - a subcutaneous CGRP monoclonal or Botox PREEMPT might fit your life better.
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Have the older prophylactics really been tried?
NICE TA871 wants three classes, at proper dose, for long enough.
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Is anyone reviewing whether it is working?
A headache diary and a 12–24-week review decide continuation. Both should be built into the plan from the start.
When it helps
When Vyepti is the right step.
The situations where NICE TA871 says eptinezumab is on the table, plus the one red flag that means an emergency rather than an appointment.
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Chronic migraine, ≥15 headache days/month
Fifteen or more headache days a month, at least eight of them migraine - the NICE TA871 threshold for eptinezumab.
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Three prior prophylactics failed
Propranolol, topiramate, amitriptyline, candesartan or valproate tried at proper dose and duration, and stopped for lack of effect or side-effects.
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Botox PREEMPT tried or not tolerated
For many patients Botox comes before Vyepti; for others it has failed or was declined. Either route can qualify.
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Other CGRP mAbs insufficient
Erenumab, fremanezumab or galcanezumab tried without adequate response - a switch to IV eptinezumab is a recognised next step.
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Rapid onset needed
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Quarterly dosing preferred
One IV every three months rather than a monthly subcutaneous injection - simpler for some patients and workplaces.
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Medication overuse addressed
If codeine, triptans or over-the-counter analgesics are being used most days, that needs sorting first, before any infusion is booked.
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Red flag: new or changing headache
Sudden severe headache, headache with fever and neck stiffness, or a new neurological deficit is an emergency - A&E, not a clinic booking.
Treatment options
Vyepti is one option - not the only one.
What each option on the table actually involves - and which fits which pattern of chronic migraine.
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Vyepti 100 mg IV
The standard first dose under NICE TA871 - one 30-minute infusion every three months.
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Vyepti 300 mg IV
The higher dose, considered when 100 mg has not produced an adequate response after two cycles.
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Erenumab (Aimovig) SC
Monthly subcutaneous CGRP-receptor antibody - the receptor target rather than CGRP itself. Self-injected at home.
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Fremanezumab (Ajovy) SC
Monthly or quarterly subcutaneous CGRP antibody - a self-injection alternative when IV is not preferred.
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Galcanezumab (Emgality) SC
Monthly subcutaneous CGRP antibody, loading dose then maintenance - another self-injection route.
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Botox PREEMPT (NICE TA260)
31 injections around the head and neck every 12 weeks. Often the step before a CGRP monoclonal on NHS pathways.
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Oral prophylactics
Propranolol, topiramate, amitriptyline, candesartan or valproate - the older classes NICE expects to have been tried first.
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Consultation only
An honest discussion of whether a CGRP monoclonal - and specifically Vyepti - is the right step.
Safety and side-effects
What to expect - honestly.
Vyepti is generally well tolerated. The things worth planning are the cardiovascular check, the pregnancy conversation, and knowing which post-infusion symptoms are normal.
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Nasopharyngitis and fatigue are common
A mild cold-like feeling and tiredness in the days after the infusion are the most frequently reported effects - usually settle within a week.
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Injection-site or infusion reaction
Redness, warmth or mild discomfort at the cannula site is common. Systemic reactions during the infusion are uncommon but the nurse is watching.
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Hypersensitivity and anaphylaxis are rare
Because anaphylaxis has been reported, Vyepti is only given in a facility with resuscitation equipment and trained staff - never at home.
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Constipation and dizziness
Reported at low rates in trials. Constipation can persist for weeks - worth mentioning at the follow-up.
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Cardiovascular caution
CGRP plays a role in vasodilation. Raynaud’s, uncontrolled hypertension or significant vascular disease are reasons for extra caution - sometimes for choosing a different agent.
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Pregnancy and breastfeeding
Vyepti should be avoided in pregnancy and while breastfeeding, and a wash-out period is advised if pregnancy is planned. Discuss with the neurologist before the first infusion.
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Anti-drug antibodies
A minority of patients develop antibodies to eptinezumab that can reduce its effect - one of the reasons ongoing diary review matters.
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Long-term safety is still emerging
Approved by NICE in 2023 (US 2020). Trial data are reassuring at 4+ years; real-world long-term data continue to accumulate.
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Red flags after infusion
Severe rash, breathlessness, facial swelling or chest pain in the hours after infusion are not normal - call the clinic or 999.
Reading your infusion note
Your infusion note in four parts. Read the last one first.
Whichever dose was used, the note the neurologist sends you keeps to the same shape.
A quiet reminder
Neurology language is precise and can read coldly - ask for anything unclear to be put in plain English.
If you would like the note talked through before your review, just ask your neurologist.
- 01 Header
Diagnosis and NICE eligibility
Chronic migraine confirmed, headache days per month at baseline, and the three prior prophylactic classes that failed - the NICE TA871 record.
- 02 Dose
Dose, batch and infusion detail
100 mg or 300 mg eptinezumab, batch number, infusion duration, cannula site, observations before, during and after.
- 03 Findings
Response so far and diary
Migraine days per month since starting, HIT-6/MIDAS/MSQ scores, acute medication use, and any adverse effects reported.
- 04 Impression
Plan, next infusion and review
Read this first: whether to continue, whether to escalate to 300 mg, when the next infusion is due, and when the 12–24-week continuation review will happen.
Recognised by major UK insurers
Cover for CGRP monoclonal antibodies varies by insurer. Most will fund where NICE TA871 criteria are met and a specialist neurologist has recommended treatment.
Frequently asked
Everything patients commonly ask about Vyepti infusion therapy.
Quick answers on eligibility, cost, how quickly it works, and what happens if it does not.
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What is Vyepti and how is it different from the other CGRP treatments?
Vyepti (eptinezumab) is a humanised IgG1 monoclonal antibody that binds to CGRP itself - the peptide implicated in migraine attacks - and blocks its vasodilatory and neurogenic-inflammatory effects. It is given as a 30-minute IV infusion every three months. Erenumab, fremanezumab and galcanezumab are subcutaneous monthly (or quarterly) injections and, in erenumab’s case, target the CGRP receptor rather than the peptide.
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Am I eligible for Vyepti on the NHS?
NICE TA871 (2023) recommends eptinezumab for chronic migraine - at least 15 headache days a month, with at least 8 migraine days - in adults who have failed at least three prior prophylactic treatments from different classes, or in whom those treatments are contraindicated or not tolerated. Specialist neurology confirms eligibility.
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What prophylactics must I have tried first?
The NICE-expected classes include propranolol, topiramate, amitriptyline, candesartan and sodium valproate (valproate is avoided in anyone who could become pregnant). Botox PREEMPT under NICE TA260 is also part of many pathways before or alongside a CGRP monoclonal.
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How quickly does Vyepti work?
The PROMISE-2 trial showed benefit within the first day for many patients, with 61 per cent of those on the 100 mg dose achieving a 50 per cent or greater reduction in migraine days at 12 weeks, versus 39 per cent on placebo. Effect is sustained through the three-month cycle.
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How much does Vyepti cost privately in the UK?
The 300 mg higher dose is £1,800–£2,800 per infusion. NHS-funded access is available for patients who meet NICE TA871 criteria.
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What are the main side-effects?
The commonest are nasopharyngitis (cold-like symptoms), fatigue and mild infusion-site reactions. Hypersensitivity, including rare anaphylaxis, is why the infusion is given in a proper facility. Constipation and dizziness occur less often. Long-term safety data are still accumulating.
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What if it does not work?
A 12–24-week review decides whether to continue. Options if response is inadequate include escalating to the 300 mg dose, switching to a different CGRP antibody, adding Botox PREEMPT, or reconsidering the diagnosis. Stopping is a legitimate option too.
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Can I have Vyepti in pregnancy?
No. Vyepti should be avoided in pregnancy and while breastfeeding, and a wash-out period is recommended before conception. If you are planning a pregnancy, tell the neurologist before the first infusion.
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