CGRP antibody therapy in patients with drug resistant migraine and chronic daily headache: a real-world experience

Abstract

Background Calcitonin gene-related peptide (CGRP) (receptor) antibodies (erenumab, fremanezumab and galcanezumab) are increasingly used in prophylactic treatment of migraine. In the approval studies, severely affected patients with migraine and chronic daily headache without any headache free days were excluded. Thus, less is known about the effectiveness of CGRP antibody treatment in this cohort. Methods Clinical routine data of 32 patients with migraine and daily headache were analysed after three months of treatment with a CGRP antibody (16 erenumab, 7 galcanezumab, 9 fremanezumab), including changes of monthly headache days (MHD) monthly migraine days (MMD) and monthly acute medication intake (AMD) as well as migraine characteristics. Statistical analysis was performed with the Wilcoxon-Test. Migraine characteristics were analysed descriptively. Results The number of MHD was significantly reduced (mean reduction (standard error), p-value): (-4.2 (1.3), p = 0.009) as well as MMD (-4.3 (1.6), p = 0.033). Four patients (13 %) reached a 50 % reduction regarding MHD and 8 patients (25 %) regarding MMD, migraine duration and intensity improved under therapy. Conclusions Despite the low responder rate, CGRP antibodies can be effective at least in a few cases of severely affected patients with drug resistant migraine and chronic daily headache. Trial registration Retrospective registered.

Dural Immune Cells, CGRP, and Migraine

“…Monoclonal antibodies result in a 50% reduction in migraine days in 50% of episodic migraine patients ( 36 ). The antibodies can also be partially effective in drug resistant migraine by reducing migraine headache days (4.2 fewer headache days in a month compared to baseline) ( 37 ). CGRP antibodies have fewer adverse side effects compared to other prophylactics ( 38 ).…”

Treatment of resistant chronic migraine with anti-CGRP monoclonal antibodies: a systematic review

“…An example of a real-world study is the work carried out by Barbanti and co-workers that reported that a 48 week long treatment with erenumab granted persistent effectiveness, safety and tolerability in patients with chronic migraine, previously unresponsive to more than 3 preventive treatments [ 74 ]. There are other examples of real-world practical clinical studies, like those carried out by Torres-Ferrús and co-workers [ 90 ] and by Scheffler and co-workers [ 91 ] confirming that anti-CGRP mAb are effective in patients with resistant migraine. Another real-world study carried out in 2021, in Italy, to answer some questions about anti-CGRP mAb (erenumab and galcanezumab) effects on patient´s migraine after one year of treatment, anti-CGRP mAb discontinuation and follow-up during 3 months revealed rather interesting results.…”

The Efficacy of Japanese Herbal Kampo Medicine as an Acute and Prophylactic Medication to Treat Chronic Daily Headache and Medication Overuse Headache:-Single Arm Retrospective Study

“…While determining efficacy during the two months, it is possible that CDH could recur. Some medications act rapidly, such as amitriptyline [ 32 ] and CGRP mAbs [ 25 , 33 ]. Kampo medicine can be a prophylactic medication that rapidly acts [ 7 , 18 ] and has long-term effects [ 10 ].…”

“…Monthly headache days (MHD), monthly migraine days (MMD), and monthly acute medication intake days (AMD) were defined as the monthly values over the respective observation period of 30 days. A headache day was defined as a day with any kind of headache; a migraine day was defined by patients when they had severe pain, migraine pain characteristics (pulsating, one-sided pain), aura symptoms, vegetative symptoms like phono- or photophobia, nausea, vomiting, need for rest, or when triptans were taken [ 25 ]. Headache impact test-6 (HIT-6) [ 26 ] was also investigated over the respective observation period.…”