Background and Purpose
To evaluate the 1‐year effectiveness and tolerability of galcanezumab in real life and the prognostic indicators of persistent response.
Methods
High‐frequency episodic migraine (HFEM) and chronic migraine (CM) patients treated with galcanezumab who completed a 1‐year observation were enrolled. The primary outcomes assessed during the 12 months (V1–V12) were the change in monthly migraine days (MMDs) from baseline and the response rates ≥50% in MMDs (MMD ≥50% RR). The secondary outcomes were changes in pain intensity (numerical rating scale [NRS]) and in monthly acute medication intake (MAMI).
Results
We enrolled 191 patients (77.5% CM). Twenty‐three patients (12%) dropped out, two for nonserious adverse events. At least 40% of patients took add‐on standard preventives from baseline to V12. At V12, MMDs were reduced by 6.0 days in HFEM and by 11.9 days in CM patients (both p < 0.00001); NRS and MAMI were also decreased in both groups (p < 0.00001). One‐hundred eight (56.5%) patients presented MMD ≥50% RR for 9 cumulative months (interquartile range=8): we defined this value as the cutoff for a persistent response. Persistent responders were less likely to have a higher body mass index (BMI) (p = 0.007) but more frequently had a good response to triptans (p = 0.005) and MMD ≥50% RR at V1 (p < 0.0000001). Patients without a persistent response were on add‐on therapy for longer periods of time (p < 0.001).
Conclusions
Galcanezumab was effective and well‐tolerated in the 1‐year term, with most patients presenting MMD ≥50% RR for at least 9 months. Triptan response, lower BMI, and MMD ≥50% RR in the first month emerged as predictive factors for a persistent response.
The migrainous brain is known to have a series of peculiarity in terms of metabolism, performances, emotions, and pain perception. This particularity seems to involve also the oneiric activity. Aimed to increase our knowledge about this topic, the present study tries to investigate migraineurs’ dreams by both an analytic qualitative and a semiquantitative perspectives. With an ad hoc questionnaire compiled each day at the awakening, we explored the frequency of dreams, the involved sensory system (visual, auditory, olfactory, and gustative), and the fragmentation of sleep. We found a higher frequency of dreams among migraineurs, partially linked to sleep discontinuation. The most relevant qualitative difference that emerged was the absolute higher frequency of gustative and olfactory dreams among migraineurs. All these peculiar characteristics were typical of the patients without aura, whereas the subgroup with aura did not differ from controls.
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