Abstract
BackgroundCalcitonin 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.MethodsClinical 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.ResultsThe 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.ConclusionsDespite 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 registrationRetrospective registered.
Highlights
Calcitonin gene-related peptide (CGRP) antibodies are increasingly used in prophylactic treatment of migraine
Aura and duration of the disease, comedication and statistics about monthly migraine days (MMD), monthly headache days (MHD) and acute medication intake (AMD) before and after treatment are summarized in Table 1 (Table 1 here)
Regarding medication overuse headache (MOH), 40 % (n = 12 of 30) before and 17 % (n = 5 of 30) after treatment had more than 10 acute medication intake days per month
Summary
Calcitonin gene-related peptide (CGRP) (receptor) antibodies (erenumab, fremanezumab and galcanezumab) are increasingly used in prophylactic treatment of migraine. Severely affected patients with migraine and chronic daily headache without any headache free days were excluded. Monoclonal calcitonin gene-related peptide (CGRP) antibodies (in Europe erenumab, fremanezumab and galcanezumab) are being used more often in the prophylactic therapy of migraine. All protocols of the approval studies excluded or had at least strong limitations regarding the severely affected patients with chronic daily headache (CDH) without any headache free days [4–6]. These patients were excluded from the trials primarily due to the expected poor response to therapy. We analysed the therapeutic effectiveness of CGRP antibodies in patients with migraine and daily headache after 3 months of treatment
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