Erenumab in the Treatment of Comorbid Trigeminal Neuralgia in Patients With Migraine

Abstract

BackgroundSurgical treatment for trigeminal neuralgia (TN) sometimes becomes difficult. Erenumab, an anti-calcitonin gene-related peptide (CGRP)-receptor monoclonal antibody, is used for migraine and potentially has efficacy for TN. MethodWe retrospectively investigated six migraine patients with comorbidity treated with 70 mg of erenumab. Monthly headache days and a numerical rating scale (NRS) of TN were evaluated before, one, and three months after erenumab administration. ResultsBefore being treated with 70 mg of erenumab, the six migraine patients with comorbid TN had taken at least one sort of preventative medication, but it had been ineffective. During the three-month erenumab use, previous medications were continued. The median age was 71 years (range 59-87). The six patients (five females and one male) had episodic migraine. Three had TN due to vessels, one had TN due to a tumor, one had TN without neurovascular compression, and one had an undetermined etiology. Five (83%) of the six patients reported improved NRS of TN. The median NRS of TN before, one, and three months after treatment were 8 (7-10), 3.5 (0-10), and 2 (0-5, n=4). Monthly headache days were 4 (4-10), 2.5 (0-4), and 1 (1-2, n=4). There were no side effects of erenumab. ConclusionSurgical treatment sometimes cannot be performed for those with TN. Our findings were preliminary and a bigger sample size is required for this study to draw firmer conclusions. However, it is possible, although rare, that there are migraine patients for whom the NRS of comorbid TN improves with the use of erenumab, an anti-CGRP receptor monoclonal antibody.

A case report: new-onset nummular headache after stenting of the middle cerebral artery

“…The patient is currently being treated with gabapentin 600 mg per day and if the treatment remains ineffective after increasing the dosage. We may consider treating the patient with Erenumab, an anti-calcitonin gene-related peptide (CGRP) receptor monoclonal antibody [ 8 ].…”

Therapeutic Approach for Trigeminal Neuralgia: A Systematic Review

“…CGRP plays a pivotal role in the formation and maintenance of NP. This trial is an expanded application of aimovig (erenumab) to TN [72][73][74].…”

Calcitonin gene‐related peptide and persistent corneal pain: A trigeminal nerve sensitization perspective

“…[88] Interestingly, erenumab effectively improved the symptoms of trigeminal neuralgia in other clinical trials. [89,90] An anti-CGRP monoclonal antibody (mAb) elicited a 30% response in 32% of patients with migraines after three treatment cycles and a 50% response in 12%. [91] As a preventive treatment for chronic migraines, fremanezumab (an anti-CGRP antibody) reduced the frequency of headaches in 12 weeks.…”

“…Palmatine Inhibiting the expression of CGRP and its receptors Trigeminal neuralgia [77] Tetramethylpyrazine Decrease in expression level of CGRP Trigeminal neuralgia [78] Emodin CGRP was significantly decreased Trigeminal neuralgia [79] Xiongmatang CGRP positive expression, mRNA expression, and protein expression reduction Migraine [80] Botulinum toxin type A CGRP levels decrease significantly Trigeminal neuralgia [81] MK-8825 CGRP receptor blocking Trigeminal neuropathic pain [83] Monoclonal anti-CGRP antibody (Sigma) Decreased with the anti-CGRP antibody The infraorbital nerve ligation modelc [84] Rimegepant CGRP receptor blocking Migraine [85] Galcanezumab CGRP monoclonal antibody SUNCT [86] Monoclonal anti-CGRP antibody (Sigma) Anti-CGRP antibody Trigeminal neuropathic pain [87] Erenumab CGRP receptor monoclonal antibody Trigeminal neuralgia [88] Erenumab CGRP receptor monoclonal antibody Trigeminal neuralgia [89] Erenumab CGRP receptor monoclonal antibody Trigeminal neuralgia [90] Galcanezumab/Fremanezumab CGRP monoclonal antibody Migrainec [91] Fremanezumab CGRP monoclonal antibody Chronic migraine [92] FKBP51 CGRP decrease CRS-induced corneal hyperalgesia [95] Resiniferatoxin Loss of CGRP immunoreactivity Capsaicin eye wipe [96] Abbreviations: CGRP, calcitonin gene-related peptide; CRS, chronic restraint stress; FKBP51, FK506-binding protein 5; SUNCT, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing.…”

“…However, a prospective clinical study demonstrated that erenumab (an anti‐CGRP receptor antibody) did not reduce pain scores in patients with trigeminal neuralgia [88] . Interestingly, erenumab effectively improved the symptoms of trigeminal neuralgia in other clinical trials [89,90] . An anti‐CGRP monoclonal antibody (mAb) elicited a 30% response in 32% of patients with migraines after three treatment cycles and a 50% response in 12% [91] .…”