Hellenic Headache Society Recommendations for the Use of Monoclonal Antibodies Targeting the Calcitonin Gene-Related Peptide Pathway for the Prevention of Migraine and Cluster Headache—2023 Update

Abstract

The confirmed involvement of the neuropeptide calcitonin gene-related peptide (CGRP) in the pathophysiology of migraine has led to the development of treatments, which for the first time are specific to migraine and mechanism based, in contrast to repurposed traditional prophylactic anti-migraine medications. Thus, in the last 5 years, the European Medicines Agency (EMA) approved four monoclonal antibodies that target either the CGRP ligand (eptinezumab, fremanezumab, and galcanezumab) or the CGRP receptor (erenumab). These anti-CGRP therapies are indicated for use in people with migraine who have more than 4 migraine days per month. In this consensus article, the Hellenic Headache Society highlights the indications and treatment protocols of these novel anti-migraine therapies, aiming to assist Greek neurologists in the optimal management of people with migraine. The recommendations are based on data from phase 3 randomized-controlled clinical trials, the recent European Headache Federation (EHF) recommendations, a consensus article under the auspices of both the EHF and the European Academy of Neurology (EAN), recent real-world evidence studies, and the authors’ acquired clinical experience.

Improvement of comorbid anxiety and depression in patients with migraine treated with injectable preventive calcitonin gene-related peptide antagonists: Review of clinical evidence

“…Many international guidelines and consensus statements provide recommendations on using monoclonal antibodies targeting the CGRP pathway for migraine prevention (Ailani, Burch, Robbins, & Society, 2021; Mitsikostas et al, 2023 , Sacco et al, 2022 ). Nevertheless, not all of them have addressed the simultaneous presence of depression and anxiety in migraine patients.…”

Predictors of galcanezumab response in a real-world study of Korean patients with migraine

“…Our current study might be closer to a real response to galcanezumab, while our previous study reflects a response rate of galcanezumab in highly treatment-resistant migraine. Given the overarching importance of migraine as a substantial public health issue 42 – 46 , the integration of high-cost innovative medications such as galcanezumab while adhering to safety recommendations 47 , assumes a critical role in influencing treatment strategies. This contribution holds the potential to enhance migraine patient outcomes and elevate overall quality of life.…”