Impact of COVID-19 on chronic migraine treated with erenumab: a case report

Abstract

Background Headache is a frequent symptom of the novel coronavirus 19 disease . To date, there are limited information on how COVID-19 affects migraine and its treatment. Case description A 47-year-old patient, suffering from chronic migraine and medication-overuse headache, in September 2020 started erenumab at 70 mg once monthly. Two months later, monthly migraine days decreased from 20 to 5. On the third month, the patient developed mild COVID-19 symptoms, experiencing extreme fatigue, hyposmia, and attention deficit, resulting positive for SARS-Cov-2 RNA. A significant increase in migraine attacks frequency was reported. Brain MRI and EEG were normal. Erenumab was increased to 140 mg/month, and attacks decreased to 3 monthly migraine days and remained stable. All the headaches experienced by our patient during the infection fulfilled the criteria of the migraine attacks, without tensive-like features. Conclusion We report the first case showing the effects of SARS-CoV-2 infection in a patient with chronic migraine and medication-overuse headache treated with erenumab. Our case description suggests that inflammatory processes induced by SARS-CoV-2 infection may increase the frequency of migraine attacks, probably through an activation of the trigeminovascular system. Whether treatment with CGRP receptor antagonist may influence COVID is still debated. Additional studies regarding anti-CGRP monoclonal antibodies in COVID-19 patients are warranted.

Assessment and characteristics of Erenumab therapy on migraine management

“…The increased severity was noted to be significantly higher with elder subjects. In agreement, Grassini et al ( Grassini et al, 2021 ), Arca and Starling ( Arca and Starling 2020 ) reported a significant exacerbation of headache attacks during COVID-19 infection in a previous case report. Patients, on the other hand, developed pneumonia and reported various clinical symptoms suggestive of SARS-CoV-2-related meningoencephalitis.…”

“…Meningoencephalitis caused by a viral agent directly invading the brain, metabolic encephalopathy, and cytokine release syndrome are all possible explanations. (CRS), ( Arca and Starling, 2020 , Grassini et al, 2021 ).…”

Migraine inhibitor olcegepant reduces weight loss and IL-6 release in SARS-CoV-2 infected older mice with neurological signs

“…COVID-19 symptoms are more severe and mortality rates are higher in aged human patients, adding significance to our results. Further, two relatively recent case studies showed that increased headaches after SARS-CoV-2 infection can be treated with CGRP monoclonal antibodies (Grassini et al 2021; Ozkan et al 2022). Our study suggests that olcegepant or other CGRP treatments may be further explored particularly to treat headaches or migraines in aged individuals and/or those with high IL-6 levels upon COVID-19 infection.…”

Monoclonal Antibodies Against Calcitonin Gene-related Peptide for Migraine Prophylaxis: A Systematic Review of Real-world Data

“…Single reports on effectiveness without adverse events cover the exposure to Erenumab in the first 2 weeks of pregnancy [109], during breast feeding [113], and in myasthenia gravis treated with immunoglobulins [123]. In one patient each, Erenumab and fremanenzumab were effective in COVID-19-related migraine exacerbations [106,112] and in two patients use of rimegepant during treatment with Erenumab was found effective and well tolerated [122]. Notably, no recommendation concerning the safety in these conditions can be given based on this anecdotal evidence.…”