Abstract
BackgroundTriptans and erenumab are both migraine-specific agents acting on the calcitonin gene-related peptide pathway. Therefore, response to triptans might be associated with response to erenumab.Main bodyIn our study, consecutive patients referring to the Headache Centers of the Abruzzo region from January 2019 to March 2020 and treated with erenumab were interviewed about past use and efficacy of triptans. Triptan users were classified as ‘triptan responders’ if they were headache-free 2 h after treating ≥3 migraine attacks with ≥1 triptan. We considered patients as ‘erenumab responders’, if they had a ≥ 50% mean reduction in monthly migraine days between the 4th and the 6th month from treatment start compared with baseline. Of 91 triptan users, 73 (80.2%) were triptan responders and 58 (63.7%) were erenumab responders. The odds ratio of being erenumab responder was 3.64 (95% CI, 1.25–10.64) for triptan users as compared to non-users. (P = 0.014). Besides, starting erenumab improved triptan response in both erenumab responders and non-responders.ConclusionsOur data of an association between response to triptans and response to erenumab can be useful for patient advice and to improve the understanding of migraine pathophysiology and treatment.
Highlights
Triptans and erenumab are both migraine-specific agents acting on the calcitonin gene-related peptide pathway
Despite the high burden of migraine, preventive treatments were not disease-specific until the advent of monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway [2, 3]
Triptans are agonists of the 5-hydroxytryptamine (5-HT) receptors 5HT1B, 5-HT1D and 5-HT1F [5]. 5-HT1B and 5-HT1D receptors are localized in trigeminal ganglia and trigeminal nerves; 5-HT1D receptor are detected in trigeminal nerves projecting peripherally to the dural vasculature to inhibit activated trigeminal nerves and prevent vasoactive neuropeptide release, and centrally to the brainstrem trigeminal nuclei to interrupt pain signal transmission [6]
Summary
Triptans and erenumab are both migraine-specific agents acting on the calcitonin gene-related peptide pathway. Despite the high burden of migraine, preventive treatments were not disease-specific until the advent of monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway [2, 3]. At the Frattale et al The Journal of Headache and Pain (2021) 22:1 peripheral level, triptans constrict extracerebral blood vessels and reduce trigeminal sensory nerve activation, inhibiting vasoactive peptide release including substance P and CGRP [7]. It can be speculated that migraineurs whose attacks respond to triptans might have a favorable response to the new migraine-specific preventive treatments
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