scholarly journals Anti-CGRP monoclonal antibodies in chronic migraine with medication overuse: real-life effectiveness and predictors of response at 6 months

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Edoardo Caronna ◽  
Victor José Gallardo ◽  
Alicia Alpuente ◽  
Marta Torres-Ferrus ◽  
Patricia Pozo-Rosich
Keyword(s):  
Monoclonal Antibodies ◽  
Chronic Migraine ◽  
Medication Overuse ◽  
Real Life ◽  
Daily Practice ◽  
Headache Frequency ◽  
Electronic Diary ◽  
Life Effectiveness ◽  
Medication Intake ◽  
Acute Medication

Abstract Background In daily practice, anti-CGRP monoclonal antibodies (MAbs) may be useful in chronic migraine (CM) with medication overuse (MO), but data is limited. We evaluated their effectiveness in a real-life clinical cohort. Methods This is a prospective study conducted in CM patients with and without medication overuse treated with monthly MAbs during 6 months (erenumab/galcanezumab). We collected headache characteristics, including acute medication intake, through an electronic diary. We compared patients (1) with and without MO at baseline, (2) with and without ongoing MO after treatment, defining MO resolution as < 10 or 15 days/month of acute medication intake, according to analgesic type, during the 6-month treatment. Results Of 139 CM patients completing 6-month treatment with anti-CGRP MAbs, 71.2% (99/139) had MO at baseline. After 6 months, patients with and without MO at baseline had significant and similar proportions of ≥50% reduction in migraine days/month (MO: 63.6% vs. non-MO: 57.5%, p = 0.500). 60.6% (60/99) no longer satisfied MO definition. Reduction in headache frequency compared to baseline occurred in both MO-ongoing and MO-resolution group, although those who stopped overusing had a greater improvement (headache days/month: − 13.4 ± 7.6 vs. -7.8 ± 7.2, p < 0.0001). No differences in MO resolution were observed according to the MAbs used. Baseline lower pain severity was associated with MO resolution (OR [95%]:0.236[0.054–0.975]; p = 0.049). Conclusions In real-life anti-CGRP MAbs are as effective in CM patients with MO as in patients without it and facilitate MO cessation. Reduction in headache frequency and acute medication days/month occurs regardless of whether patients stop overusing or not.

scholarly journals Pooled retrospective analysis of 70 mg erenumab in episodic and chronic migraine: a two tertiary headache centers experience during clinical practice

2021 ◽  
Author(s):  
P. Storch ◽  
P. Burow ◽  
B. Möller ◽  
T. Kraya ◽  
S. Heintz ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Retrospective Analysis ◽  
Medication Overuse ◽  
Real Life ◽  
Clinical Trial Data ◽  
Headache Intensity ◽  
Acute Medication ◽  
Calcitonin Gene ◽  
Before And After ◽  
Male Patients

AbstractErenumab is a monoclonal antibody, targeted against the calcitonin gene-related peptide (CGRP) receptor. Clinical studies have demonstrated prophylactic efficacy in both episodic (EM) and chronic migraine (CM). The aim of the present study is to evaluate the efficacy of treatment in tertiary headache centers under real-life conditions. In a retrospective analysis, the period of 3 months before and after initiation of erenumab therapy was compared. Relevant parameters (headache days, headache intensity, headache duration, acute medication, previous prophylaxis treatments) were collected from medical charts of all migraine patients (N = 82) who started treatment with erenumab between November 1st 2018 and May 1st 2019 at two tertiary headache centers in Germany. The sample included 68 female (82.9%) and 14 male patients aged between 22 and 78 years (mean 51.1 years, SD 10.5 years). Of these patients, 57.3% met the criteria for CM and 56.9% overused acute medication. Under therapy with erenumab, a significant reduction of headache days was observed from the first month on. The effect was most pronounced in the third month with a decrease in monthly headache days from 16.6 to 11.6 days (p < 0.001). There was also a significant reduction in reported headache intensity (p = 0.004) and average duration of headache attacks (p = 0.016). The 50% responder rate in patients with CM was lower in the first month compared to EM but then increased similarly to EM. Patients with medication overuse (MO) also responded to the therapy. There was a reduction in medication overuse from 57% at baseline to 29% after therapy (p = 0.011). Overall, a positive result of treatment with erenumab can be shown in a highly selected sample with severely affected migraine patients and a refractory course prior to treatment. This re-confirms the clinical trial data also for this highly selected group.

A prospective pilot study of the effect on catecholamines of mindfulness training vs pharmacological prophylaxis in patients with chronic migraine and medication overuse headache

Cephalalgia ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 655-664 ◽  
Author(s):  
Licia Grazzi ◽  
Alberto Raggi ◽  
Domenico D’Amico ◽  
Emanuela Sansone ◽  
Matilde Leonardi ◽  
...  
Keyword(s):  
Treatment Group ◽  
Chronic Migraine ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Headache Frequency ◽  
Pharmacological Prophylaxis ◽  
Prophylaxis Group ◽  
Medication Intake ◽  
Tyrosine Metabolism ◽  
History Of

Aim To address whether, in patients with chronic migraine and medication overuse headache, mindfulness-based treatment is associated with changes in plasma levels of catecholamines and elusive amines that are similar to those observed in patients undergoing pharmacological prophylaxis. Methods In this non-randomized, clinic-based effectiveness study, patients aged 18–65, with a history of chronic migraine ≥ 10 years and overuse of triptans or non-steroidal anti-inflammatory drugs ≥ 5 years, were enrolled. Upon completion of a structured withdrawal program, patients received either pharmacological prophylaxis or six weekly sessions of mindfulness-based treatment and were followed for 12 months. Daily headache diaries were used to record headache frequency and medication intake; catecholamines (noradrenaline, epinephrine and dopamine) and levels of elusive amines were assayed from poor platelet plasma. Results Complete follow-up data were available for 15 patients in the pharmacological prophylaxis-group (14 females, average age 44.1) and 14 in the mindfulness treatment-group (all females, average age 46.4), and all variables were comparable between groups at baseline. At 12 months, significant improvement ( p < .001) was found in the pharmacological prophylaxis group for headache frequency and medication intake (by 51% and 48.7%, respectively), noradrenaline, epinephrine and dopamine (by 98.7%, 120.8% and 501.9%, respectively); patients in the mindfulness treatment-group performed similarly. For elusive amines, no longitudinal changes were found. Conclusions The similar improvement trends observed in the two groups of patients further support the utility of mindfulness-based treatment in migraine care, and reinforce the hypothesis that alteration and normalization of tyrosine metabolism are implicated in migraine chronification and in remission of chronic migraine.

Acupuncture versus topiramate in chronic migraine prophylaxis: A randomized clinical trial

Cephalalgia ◽  
2011 ◽  
Vol 31 (15) ◽  
pp. 1510-1521 ◽  
Author(s):  
C-P Yang ◽  
M-H Chang ◽  
P-E Liu ◽  
T-C Li ◽  
C-L Hsieh ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Prophylactic Treatment ◽  
Medication Overuse ◽  
Severe Headache ◽  
Migraine Prophylaxis ◽  
Acupuncture Group ◽  
Maintenance Period ◽  
Acute Medication ◽  
Group A ◽  
The Mean

Background: The aim of this study was to investigate the efficacy and tolerability of acupuncture compared with topiramate treatment in chronic migraine (CM) prophylaxis. Methods: A total of 66 consecutive and prospective CM patients were randomly divided into two treatment arms: 1) acupuncture group: acupuncture administered in 24 sessions over 12 weeks (n = 33); and 2) topiramate group: a 4-week titration, initiated at 25 mg/day and increased by 25 mg/day weekly to a maximum of 100 mg/day followed by an 8-week maintenance period (n = 33). Results: A significantly larger decrease in the mean monthly number of moderate/severe headache days (primary end point) from 20.2 ± 1.5 days to 9.8 ± 2.8 days was observed in the acupuncture group compared with 19.8 ± 1.7 days to 12.0 ± 4.1 days in the topiramate group (p < .01) Significant differences favoring acupuncture were also observed for all secondary efficacy variables. These significant differences still existed when we focused on those patients who were overusing acute medication. Adverse events occurred in 6% of acupuncture group and 66% of topiramate group. Conclusion: We suggest that acupuncture could be considered a treatment option for CM patients willing to undergo this prophylactic treatment, even for those patients with medication overuse.

Chronic Migraine and Medication-Overuse Headache Through the Ages

Cephalalgia ◽  
2005 ◽  
Vol 25 (5) ◽  
pp. 378-390 ◽  
Author(s):  
CJ Boes ◽  
DJ Capobianco
Keyword(s):  
Chronic Migraine ◽  
English Language ◽  
Medication Overuse ◽  
International Headache Society ◽  
Medication Overuse Headache ◽  
Headache Frequency ◽  
Ihs Criteria ◽  
Acute Headache

We set out to review early descriptions of chronic migraine and medication-overuse headache. The International Headache Society (IHS) recently gave criteria for chronic migraine and medication-overuse headache. Chronic migraine was absent from the 1988 IHS criteria. Peters and Horton described ergotamine-overuse headache in 1951. In the 1980s it was more fully appreciated that overuse of other acute headache medications could increase headache frequency. We reviewed published English-language papers and book chapters. Willis (1672), Oppenheim (1900), Collier (1922), Balyeat (1933), and von Storch (1937) all described chronic migraine. Lennox (1934), O'Sullivan (1936), Silfverskiöld (1947), Graham (1955), Friedman (1955), and Lippman (1955) wrote about ergotamine-overuse headache. Graham (1955), Friedman (1955), Lippman (1955), and Horton and Peters (1963) outlined withdrawal protocols. Chronic migraine has been mentioned in the literature for centuries, while medication-overuse headache has been written about for decades. Graham, Friedman, and Lippman deserve credit for separately reporting the first ergotamine withdrawal programmes.

scholarly journals Investigating the Effects of COVID-19 Quarantine on Migraine: Data from the Italian National Headache Registry (RICe)

2020 ◽  
Author(s):  
Marianna Delussi ◽  
Eleonora Gentile ◽  
Gianluca Coppola ◽  
Addolorata Maria Pia Prudenzano ◽  
Innocenzo Rainero ◽  
...  
Keyword(s):  
Northern Italy ◽  
Psychological Effects ◽  
Headache Frequency ◽  
Inclusion Criteria ◽  
Medication Intake ◽  
Home Improvement ◽  
Migraine Frequency ◽  
Acute Medication ◽  
Staying At Home ◽  
Resilient Behavior

Abstract BACKGROUND Previous studies during the SARS and Ebola pandemics have shown that quarantine is associated with several negative psychological effects. Although it is possible that quarantine for the current COVID-19 pandemic affects migraine burden, no information is currently available on this i AIM: In this study, we aimed: a) to explore the effect of quarantine on migraine frequency, severity and days with acute medication intake, and b) to evaluate whether migraine, changes in lifestyle, and emotions. were affected in a different manner in three geographic Italian areas with diverse COVID-19 diffusion, METHODS We interviewed patients included in the observational Italian registry of headache (Registro Italiano Cefalee, RICe), retrospectively collecting information on main headache features, lifestyles factors, emotions, individual infection status, and perception for COVID-19 for the two months before quarantine and during quarantine. Inclusion criteria were: age > 18; diagnosis of migraine without aura, migraine with aura, and chronic migraine; last in-person visit in the 3 months before the beginning of the quarantine. RESULTS A total of 433 migraine subjects agreed to be interviewed. We found an overall reduction in headache frequency and days with acute medication intake during the quarantine as compared to pre-quarantine. Reduction in headache frequency prevailed in patients reported more days of effective staying at home. Improvement was not evident in northern Italy. Disgust against viral infection corresponded to a reduced improvement in migraine parameters. CONCLUSIONS. Migraine patients showed a resilient behavior toward the pandemic distress. Disgust against the contagious disease, could increase migraine frequency. ssue.

scholarly journals The impact of fremanezumab on medication overuse in patients with chronic migraine: subgroup analysis of the HALO CM study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Stephen D. Silberstein ◽  
Joshua M. Cohen ◽  
Michael J. Seminerio ◽  
Ronghua Yang ◽  
Sait Ashina ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Medication Overuse ◽  
Humanized Monoclonal Antibody ◽  
Acute Medication ◽  
Calcitonin Gene ◽  
Acute Headache ◽  
Post Hoc ◽  
The Impact ◽  
Adjusted Least Squares

Abstract Background We evaluated the efficacy of fremanezumab, a fully humanized monoclonal antibody that selectively targets calcitonin gene-related peptide, in patients with chronic migraine (CM) with and without medication overuse (MO). Methods In a 12-week, phase 3 trial, patients with CM were randomized to fremanezumab quarterly (675 mg/placebo/placebo), monthly (675 mg/225 mg/225 mg), or placebo. Post hoc analyses assessed the impact of fremanezumab in patients with and without MO (monthly use of acute headache medication ≥15 days, migraine-specific acute medication ≥10 days, or combination medication ≥10 days) on efficacy outcomes, including headache days of at least moderate severity (HDs), and six-item Headache Impact Test (HIT-6) and Migraine-Specific Quality of Life (MSQoL) questionnaire scores. Results Of 1130 patients enrolled, 587 (51.9%) had baseline MO. Fremanezumab reduced placebo-adjusted least-squares mean (95% confidence interval) monthly HDs (− 2.2 [− 3.1 to − 1.2] and − 2.7 [− 3.7 to − 1.8]; P < 0.0001) in patients with MO and without MO (quarterly − 1.4 [− 2.3 to − 0.5], P = 0.0026; monthly − 1.4 [− 2.3 to − 0.6], P = 0.0017). Significantly more fremanezumab-treated patients had ≥ 50% reduction in HDs versus placebo, regardless of baseline MO (with: quarterly 70/201 [34.8%], monthly 78/198 [39.4%] vs placebo 26/188 [13.8%]; without: quarterly 71/174 [40.8%], monthly 75/177 [42.4%] vs placebo 41/183 [22.4%]). Fremanezumab improved HIT-6 and MSQoL scores. Significantly more fremanezumab-treated patients reverted to no MO (quarterly 111/201 [55.2%], monthly 120/198 [60.6%]) versus placebo (87/188 [46.3%]). Conclusions Fremanezumab is effective for prevention of migraine in patients with CM, regardless of MO, and demonstrated a benefit over placebo in reducing MO. Trial registration ClinicalTrials.gov NCT02621931 (HALO CM), registered December 12, 2012.

Erenumab efficacy in chronic migraine and medication overuse: a real-life multicentric Italian observational study

2020 ◽  
Vol 41 (S2) ◽  
pp. 489-490
Author(s):  
Francesca Schiano di Cola ◽  
Renata Rao ◽  
Salvatore Caratozzolo ◽  
Marco Di Cesare ◽  
Elisabetta Venturelli ◽  
...  
Keyword(s):  
Observational Study ◽  
Chronic Migraine ◽  
Medication Overuse ◽  
Real Life

scholarly journals Reduction in acute migraine-specific and non-specific medication use in patients treated with erenumab: post-hoc analyses of episodic and chronic migraine clinical trials

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Stewart J Tepper ◽  
Messoud Ashina ◽  
Uwe Reuter ◽  
Yngve Hallström ◽  
Gregor Broessner ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Medication Overuse Headache ◽  
Medication Use ◽  
Electronic Diary ◽  
Double Blind ◽  
Acute Medication ◽  
Specific Medication ◽  
Acute Headache ◽  
Post Hoc ◽  
Change In Mean

Abstract Background In patients with migraine, overuse of acute medication, including migraine-specific medication (MSM) such as triptans and ergots, can lead to adverse health outcomes, including development of medication overuse headache. Here, we examined the effect of erenumab on reducing acute medication use, in particular MSM, in patients with episodic migraine (EM) and chronic migraine (CM). Methods The current post-hoc analyses were based on data from the double-blind treatment phase (DBTP) of two erenumab studies, a pivotal EM (N = 955) and a pivotal CM (N = 667) trial, and their respective extensions. Patients were administered subcutaneous placebo or erenumab (70 or 140 mg) once monthly. Daily acute headache medication use (including MSM and non-MSM) was recorded using an electronic diary during a 4-week pretreatment baseline period until the end of the treatment period. Outcome measures included change in monthly acute headache medication days (HMD) in acute headache medication users at baseline, and changes in monthly MSM days (MSMD) in MSM users at baseline and non-MSMD in non-MSM users at baseline. Results In total, 60 and 78 % of patients (all acute headache medication users) with EM and CM used MSM at baseline, respectively. For acute headache medication users, the change in mean monthly acute HMD over Months 4, 5 and 6 compared with the pre-DBTP was 1.5, 2.5, and 3.0 for placebo, erenumab 70 mg and 140 mg, respectively for the EM study. The respective change in monthly MSMD in MSM users was 0.5, 2.1 and 2.8, and in monthly non-MSMD in non-MSM users was 2.3, 2.6, and 2.7. In the acute headache medication users at baseline, the change in monthly acute HMD at Month 3 compared with pre-DBTP was 3.4, 5.5, and 6.5 for placebo, erenumab 70 mg and 140 mg, respectively for the CM study. The respective change in monthly MSMD in MSM users was 2.1, 4.5, and 5.4, and in monthly non-MSMD in non-MSM users was 5.9, 6.4, and 6.6. Reductions in MSMD versus placebo were sustained in the extension periods of both studies. Erenumab was also associated with a higher proportion of MSM users achieving ≥ 50 %, ≥ 75 and 100 % reduction from baseline in monthly MSMD versus placebo in both EM and CM. Conclusions In both EM and CM, treatment with erenumab is associated with a significant and sustained reduction in the use of acute headache medication, in particular MSM. Trial registrations NCT02456740; NCT02066415; NCT02174861.

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