Effects of COVID-19 on a migrainous patient treated with erenumab: A case report

Abstract

Headache is a frequent symptom of the novel coronavirus 19 disease (COVID-19). Two distinct headache phenotypes were observed in COVID-19 patients: one showing the features of migraine attacks while another characterized by symptoms of tension-type headache. We report the effects of SARS-CoV-2 infection on a chronic migraine patient treated with erenumab. A 47 years old patient suffering of chronic migraine started, in September 2020, an anti-CGRP receptor monoclonal antibody therapy with Erenumab, at the dosage of 70 mg per month. In a two-months period, headache frequency decreased from 16 to 5 attacks per month. On the third month the patient developed mild COVID-19 symptoms, like fatigue and hyposmia, with nasopharingeal swab-test resulting positive for SARS-Cov-2 RNA. A significant increase in migraine attacks (15 per months) was reported. Brain MRI and EEG were performed, resulting normal. Erenumab was increased to 140 mg/month. After increase in anti-CGRP dosage, the frequency of migraine attacks progressively decreased to 3–4 per month and remained stable. All the headaches experienced by our patient during the infection fulfilled the criteria of the migraine attacks, without tensive like features. Our case report suggests that inflammatory processes induced by SARS-CoV-2 infection may increase the frequency of migraine attacks through an activation of the trigeminovascular system. Additional studies with anti-CGRP monoclonal antibodies in COVID-19 patients are needed.