Calcitonin gene related peptide monoclonal antibody treats headache in patients with active idiopathic intracranial hype
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(2020) 21:116
The Journal of Headache and Pain
CASE REPORT
Open Access
Calcitonin gene related peptide monoclonal antibody treats headache in patients with active idiopathic intracranial hypertension Andreas Yiangou1,2,3, James L. Mitchell1,2,3, Vivek Vijay1,2,3, Olivia Grech1,2,3, Edward Bilton4, Gareth G. Lavery1,2,3, Claire Fisher3, Julie Edwards3, Susan P. Mollan4 and Alexandra J. Sinclair1,2,3*
Abstract Background: Headache is the dominant factor for quality of life related disability in idiopathic intracranial hypertension (IIH) and typically has migraine-like characteristics. There are currently no evidence-based therapeutics for headache in IIH, and consequently this is an important unmet clinical need. Case series: We report a series of seven patients in whom headaches were the presenting feature of IIH and the headaches had migraine-like characteristics, as is typical in many IIH patients. Papilloedema settled (ocular remission) but headaches continued. These headaches responded markedly to erenumab, a monoclonal antibody targeted against the calcitonin gene related peptide (CGRP) receptor. Of note, there was a recurrence of raised ICP, as evidenced by a return of the papilloedema, however the headaches did not recur whilst treated with erenumab. Conclusions: Those with prior IIH who have their headaches successfully treated with CGRP therapy, should remain under close ocular surveillance (particularly when weight gain is evident) as papilloedema can re-occur in the absence of headache. These cases may suggest that CGRP could be a mechanistic driver for headache in patients with active IIH. Keywords: CGRP monoclonal antibody, Headache, Idiopathic intracranial hypertension, Papilloedema, Raised intracranial pressure
Introduction Idiopathic intracranial hypertension (IIH) is a chronic debilitating disease characterised by raised intracranial pressure (ICP) that typically occurs in young, obese women [1]. There is evidence of rapidly increasing incidence (350% increase in 10 years), in line with global * Correspondence: [email protected] 1 Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK 2 Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK Full list of author information is available at the end of the article
obesity trends [1, 2]. Disability in IIH is predominantly driven by debilitating headache [3]. Headaches in IIH most frequently have migraine-like characteristics [4]. Therapeutic strategies to prevent headache in IIH are an unmet need [1, 4, 5]. We report seven patients who presented with headaches in the setting of raised ICP and who met the diagnostic criteria for IIH [6], whose IIH remitted and headaches persisted. Following trials of conventional headache therapies that failed to control their headache symptoms over 12 months, they were subsequently treated with a monoclonal antibody targeted against
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