Monoclonal antibodies for chronic migraine and medication overuse headache: A real-world study

Abstract

BackgroundMedication-overuse headache is highly prevalent in tertiary care centers. It may be a cause or consequence of the overuse of symptomatic medications for migraine attacks.ObjectiveWe aimed to compare the efficacy of anti-CGRP monoclonal antibodies (mAbs) added to conventional pharmacological treatments in patients with chronic migraine (CM) and medication overuse headache (MOH).MethodsA cross-sectional, prospective, randomized, open study with real-world comparison groups of patients was carried out. The sample consisted of 200 patients with CM and MOH, who received the same approach to withdraw overused medications, started preventative treatment, and either did or did not receive mAbs.ResultsA total of 172 patients (126 women and 46 men) were included in the study and divided into two groups: group one consisting of 58 patients (control) and group two of 114 patients who used mAbs added to conventional pharmacological agents. The mean age was 44.1 ± 13.6 years, ranging from 18 to 78 years. In the 3 months follow-up after starting the treatment, both groups presented headache frequency reduction, but those with monoclonal antibodies had a significantly higher reduction in the number of headache days and symptomatic medication intake when compared to the control (p < 0.0001).ConclusionsThe addition of an anti-CGRP monoclonal antibody to the treatment for medication overuse headaches in chronic migraineurs may result in decreasing headache frequency and symptomatic medication use when compared to conventional treatments with drugs.

Calcitonin gene‐related peptide‐targeting therapies are a first‐line option for the prevention of migraine: An American Headache Society position statement update

“…Post hoc analysis of randomized controlled trial (RCT) data has also led to several other important observations. One such observation is that the CGRP‐targeting therapies are effective for migraine prevention in individuals who have pre‐existing acute medication overuse and may therefore be particularly useful in this clinical setting 25,31–34 . Open‐label extensions of RCTs of CGRP‐targeting migraine preventive therapies have shown good adherence to therapy, persistent efficacy and tolerability over time, and no emergent serious adverse effects across the class of medications 35–38 .…”

“…One such observation is that the CGRP-targeting therapies are effective for migraine prevention in individuals who have preexisting acute medication overuse and may therefore be particularly useful in this clinical setting. 25,[31][32][33][34] Open-label extensions of RCTs of CGRP-targeting migraine preventive therapies have shown good adherence to therapy, persistent efficacy and tolerability over time, and no emergent serious adverse effects across the class of medications. [35][36][37][38] Finally, such studies also show no differences in efficacy or adverse effects among individuals with migraine with aura who may have a slightly higher inherent risk for vascular events.…”

Beyond Pain Relief: Unveiling the Multifaceted Impact of Anti-CGRP/R mAbs on Comorbid Symptoms in Resistant Migraine Patients

“…We did not check for the A1.3.2 vs. A1.3.1 subgroups of CM in our cohort; however, the headache frequency was not a predictor of poor outcome in our population. More studies need to be conducted to understand if CM patients with continuous pain or MOH are less prone to responding to neuromodulation of CGRP signaling [ 72 ]. Psychiatric comorbidities were considered possible culprits and concomitant depression was more frequent in non-responders than in super-responders [ 44 ], but our data are not in line with this hypothesis.…”

Combination of anti-CGRP/CGRP-R mAbs with onabotulinumtoxin A as a novel therapeutic approach for refractory chronic migraine: a retrospective study of real-world clinical evidence and a protocol for a double-blind, randomized clinical trial to establish the efficacy and safety

“…Another retrospective study likewise highlighted the effectiveness of onabotulinumtoxin A as an add-on therapy to mAbs in patients suffering from refractory chronic migraine, who failed two oral migraine preventative drugs, three onabotulinumtoxin A cycles and three sessions with either fremanezumab or erenumab delivered sequentially as monotherapies ( Argyriou et al, 2022 ). Furthermore, addition of an anti-CGRP mAb to the treatment for MOH in chronic migraineurs has been recently suggested to reduce headache frequency and symptomatic medication use ( Krymchantowski et al, 2023 ). Although patient persistence with onabotulinumtoxinA is better than that seen with anti-CGRP mAbs ( Schwedt et al, 2023 ), the doses of botulinum toxin A that can be delivered are strictly limited to restrict the unwanted spread of the toxin beyond the treatment area and to preclude the development of potentially debilitating motor and autonomic side-effects.…”