Effectiveness of erenumab in chronic migraine patients with associated medication overuse headache: a prospective observ
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Effectiveness of erenumab in chronic migraine patients with associated medication overuse headache: a prospective observational study Marcella Curone 1 & Vincenzo Tullo 1 & Gennaro Bussone 1
# Fondazione Società Italiana di Neurologia 2020
Migraine has a huge health burden on headache sufferers, and because of its prevalence during the most productive years, it can be a relevant cause of lost work time, social impairment, and high costs. Medication overuse headache (MOH) is a rebound headache caused by chronic, long-term overuse of medications and symptomatic drugs treating pain often observed in migraine patients. MOH prevalence in people with chronic migraine can be up to 23% [1]. Erenumab is a fully human monoclonal antibody inhibiting the calcitonin gene–related peptide receptor (CGRPr), approved for treatment of both episodic and chronic migraine. It was the first of the group of CGRPr antagonists to be FDA authorized in 2018, and it is used to block the receptors for the protein CGRP, which plays a major role in neurogenic inflammation and pain. It has an elimination half-life of 28 days, so it is a once-monthly drug and it can be self-injected. Combination analgesics, triptans, and also opioids are the medications most commonly associated with MOH. The cornerstore of therapy in MOH is withdrawal, best in controlled environment like hospitals during detoxification. By reducing migraine attacks and restricting the acute pain medications, erenumab can break the circle of this headache so it can be potentially effective also in treating MOH. The aim of our study was to assess the efficacy of erenumab in chronic migraine patients suffering from medication overuse headache in order to verify if it can
* Marcella Curone [email protected] 1
Igea Headache Center, Casa di Cura del Policlinico, Via Marcona, 69, Milan, Italy
significantly reduce also the rebound headache due to medication overuse. A prospective single-center observational study of patients suffering from migraine fitting International Classification of Headache Disorders 3rd Edition criteria [2] for chronic migraine and MOH, treated monthly with erenumab, was performed. We assessed attack severity of migraine by the 0–10 numerical rating scale (NRS) and disability by the Migraine Impact and Disability Assessment Scale (MIDAS). Of 79 migraine patients randomized, 27 (34%) met the chronic migraine with MOH criteria, were considered eligible, and were enrolled in the study. Twenty-seven patients, 3 males and 24 females, aged 22 to 65 years, from our Headache Center were consecutively treated. Erenumab was administered during in-person visits in every 28 days subcutaneous dose of 70 mg. Patients were followed and treated for 15 months. The investigators performed an evaluation of headache diary of the patient at each visit, including all adverse events that have occurred since the last visit and all treatments taken by the patient. Patients reporting a ≥ 50% reduction of monthly migraine days and ≥ 50% reduction in days of
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