Cephalalgia : an international journal of headache最新文献

{"title":"Evaluation and treatment of headache associated with moyamoya disease - a narrative review.","authors":"Chia-Chun Chiang,&nbsp;Adnan H Shahid,&nbsp;Andrea M Harriott,&nbsp;Gretchen E Tietjen,&nbsp;Luis E Savastano,&nbsp;James P Klaas,&nbsp;Giuseppe Lanzino","doi":"10.1177/03331024211056250","DOIUrl":"https://doi.org/10.1177/03331024211056250","url":null,"abstract":"<p><strong>Background: </strong>Headache in patients with moyamoya disease is an under-addressed topic in the medical literature. Delay in the diagnosis of moyamoya disease or inappropriate treatment of headache could lead to devastating cerebrovascular outcome. With the evolving understanding of moyamoya disease, migraine pathophysiology, and various migraine-specific medications that have become available, it is crucial to provide an updated overview on this topic.</p><p><strong>Methods: </strong>We searched PubMed for keywords including <i>moyamoya disease, moyamoya syndrome, headache in moyamoya, surgical revascularization, surgical bypass, migraine and moyamoya,</i> and <i>calcitonin gene-related peptide (CGRP).</i> We summarized the literature and provide a comprehensive review of the headache presentation, possible mechanisms, the impact of various surgical revascularizations on headache in patients with moyamoya disease, and the medical management of headache incorporating novel migraine-specific treatments.<b>Results and conclusion:</b> The most common headache phenotype is migraine; tension-type headache, hemiplegic migraine, and cluster headache have also been reported. Most patients experience improvement of headache after surgical revascularization, though some patients report worsening, or new-onset headache after surgery. Given the complexity of moyamoya disease, careful consideration of different types of medical therapy for headache is necessary to improve the quality of life while not increasing the risk of adverse cerebrovascular events. More prospective studies are warranted to better understand and manage headache in patients with moyamoya disease.</p>","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"542-552"},"PeriodicalIF":4.9,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39719623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis of idiopathic intracranial hypertension - the importance of excluding secondary causes: A systematic review.","authors":"Kubra Kilic,&nbsp;Johanne Juhl Korsbæk,&nbsp;Rigmor H Jensen,&nbsp;Vlasta Vukovic Cvetkovic","doi":"10.1177/03331024211056580","DOIUrl":"https://doi.org/10.1177/03331024211056580","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic intracranial hypertension is characterized by increased intracranial pressure without any pathological findings on neuroimaging, except for signs of high intracranial pressure. Before diagnosing idiopathic intracranial hypertension secondary causes of increased intracranial pressure should be excluded.</p><p><strong>Objective: </strong>to characterize the phenotype of patients with secondary intracranial hypertension and to identify possible risk factors for secondary intracranial hypertension.</p><p><strong>Methods: </strong>We have systematically searched the PubMed database. The publications were analyzed according to the patient phenotype, age, gender, comorbidities, body mass index/weight status, and additional medication. The results are summarized in four categories: medication, infection, hormonal induced intracranial hypertension and miscellaneous groups of diseases related to sIH.</p><p><strong>Results: </strong>We identified 105 eligible papers which included 272 cases. There were 49.6% pediatric cases. Among the adult group,70.9% were women. A total of 40.4% of all cases were obese or overweight, 27% among adults and 13.4% among pediatric cases. Increased BMI and recent weight gain, anemia, renal diseases and hypertension were the most frequent comorbidities related to sIH.</p><p><strong>Conclusion: </strong>Among sIH patients, 40.4% were obese or overweight; two thirds were women. We recommend that even patients with a typical IIH phenotype should be screened for secondary causes.</p>","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"524-541"},"PeriodicalIF":4.9,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39911410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The gut microbiome modulates nitroglycerin-induced migraine-related hyperalgesia in mice.","authors":"Li Kang,&nbsp;Wenjing Tang,&nbsp;Yaofen Zhang,&nbsp;Mingjie Zhang,&nbsp;Jing Liu,&nbsp;Yingji Li,&nbsp;Shanshan Kong,&nbsp;Dengfa Zhao,&nbsp;Shengyuan Yu","doi":"10.1177/03331024211050036","DOIUrl":"https://doi.org/10.1177/03331024211050036","url":null,"abstract":"<p><strong>Background: </strong>Gut microbiota disturbance is increasingly suggested to be involved in the pathogenesis of migraine but this connection remains unsubstantiated. This study aimed to investigate whether the gut microbiome influences migraine-related hyperalgesia.</p><p><strong>Methods: </strong>Nitroglycerin-induced hyperalgesia was evaluated in mice with different gut microbiota statuses as follows: Specific pathogen-free mice; germ-free mice; specific pathogen-free mice treated with antibiotics to deplete the gut microbiome (ABX mice); and germ-free mice transplanted with the gut microbial profile from specific pathogen-free mice (GFC mice). Moreover, nitroglycerin-induced hyperalgesia was compared between recipient mice transplanted with gut microbiota from a patient with migraine and those that received gut microbiota from a sex- and age-matched healthy control.</p><p><strong>Results: </strong>In specific pathogen-free mice, a decreased mechanical threshold in the hind paw, increased grooming time, increased c-Fos expression level and decreased calcitonin gene-related peptide expression level as well as increased tumor necrosis factor-α concentration in the trigeminal nucleus caudalis were observed after nitroglycerin administration compared with saline treatment. However, increased basal sensitivity and higher basal concentrations of TNF-α in the trigeminal nucleus caudalis were observed in germ-free and ABX mice, while no significant difference in hyperalgesia was observed between the nitroglycerin group and saline group in germ-free and ABX mice. Moreover, significant hyperalgesia was induced by nitroglycerin administration in GFC mice. The mice transplanted with the gut microbial profile from a patient with migraine had more severe nitroglycerin-induced hyperalgesia than the mice receiving microbiota from a matched healthy control.</p><p><strong>Conclusion: </strong>Our findings highlight the involvement of the gut microbiome in normal mechanical pain sensation and pathogenesis of migraine.</p>","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"490-499"},"PeriodicalIF":4.9,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39513960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Migrainous infarction of the eye: Two cases of monocular ischemic complications associated with retinal migraine.","authors":"Nikita Chhabra,&nbsp;Chia-Chun Chiang,&nbsp;Marie A Di Nome,&nbsp;Odette Houghton,&nbsp;Rachel E Carlin,&nbsp;Cumara B O'Carroll,&nbsp;David W Dodick,&nbsp;Oana M Dumitrascu","doi":"10.1177/03331024211056286","DOIUrl":"https://doi.org/10.1177/03331024211056286","url":null,"abstract":"<p><strong>Background: </strong>Retinal migraine is defined by fully reversible monocular visual phenomena. We present two cases that were complicated by permanent monocular vision deficits.</p><p><strong>Cases: </strong>A 57-year-old man with history of retinal migraine experienced persistent monocular vision loss after one stereotypical retinal migraine, progressing to finger-count vision over 4 days. He developed paracentral acute middle maculopathy that progressed to central retinal artery occlusion. A 27-year-old man with history of retinal migraine presented with persistent right eye superotemporal scotoma after a retinal migraine. Relative afferent pupillary defect and superotemporal visual field defect were noted, consistent with ischemic optic neuropathy.</p><p><strong>Conclusion: </strong>Retinal migraine can complicate with permanent monocular visual loss, suggesting potential migrainous infarction of the retina or optic nerve. A thorough cerebrovascular evaluation must be completed, which was unrevealing in our cases. Acute and preventive migraine therapy may be considered in retinal migraine patients, to mitigate rare but potentially permanent visual loss.</p>","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"553-556"},"PeriodicalIF":4.9,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39630967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prevalence and characteristics of visceral autonomic symptoms among migraineurs: A population-based study.","authors":"Mansoureh Togha,&nbsp;Fahimeh Martami,&nbsp;Elham Jafari,&nbsp;Shadi Ariyanfar,&nbsp;Seyedeh Melika Hashemi","doi":"10.1177/03331024211056849","DOIUrl":"https://doi.org/10.1177/03331024211056849","url":null,"abstract":"<p><strong>Background: </strong>There is limited evidence about visceral autonomic symptoms in the different phases of migraine attack. We evaluated the prevalence of these symptoms in migraineurs before, during, and after headache attacks. In addition, the association between migraine characteristics and visceral autonomic symptoms was investigated.</p><p><strong>Methods: </strong>A total of 605 participants who met the entry criteria were enrolled prospectively in this cross-sectional study. Participants were 18-60 years old and met the ICHD-3 criteria for migraine with or without aura. Information on the migraine symptoms was gathered from all participants in face-to-face interviews. A structured questionnaire was used to evaluate the related symptoms before, during, and after attacks. Migraine features of frequency, duration, and severity were also assessed.</p><p><strong>Results: </strong>Considering all phases, the most commonly present visceral symptom was nausea (52.9%). About half of participants reported at least one visceral symptom before the onset of attacks. While, during and after attacks, 71% and 36% of participants reported such characteristics, respectively. Notably, the migraine headache in participants with visceral symptoms was longer during attacks compared to participants without them (24.4 ± 29.6 vs. 16.8 ± 19.8; P = 0.008). Additionally, subjects with positive visceral symptoms experienced more severe migraine attacks than participants without symptoms for both the premonitory (8 ± 1.7 vs. 7.6 ± 1.8; P = 0.02) and during-attack (8.01 ± 1.7 vs. 7.09 ± 1.9; P = 0.001) phases.</p><p><strong>Conclusion: </strong>This study demonstrated that visceral symptoms were common in migraine sufferers not only during attacks but also in the premonitory and postdrome phases. Positive visceral symptoms were also associated with more burdensome headache attacks. Therefore, recognizing the phenotypic presentation of associated symptoms of migraine, especially during the pre-attack phase, could aid in early implementation of optimal management.</p>","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"500-509"},"PeriodicalIF":4.9,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39719618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic cluster headache: A study of the telencephalic and cerebellar cortical thickness.","authors":"Greta Demichelis,&nbsp;Chiara Pinardi,&nbsp;Luca Giani,&nbsp;Jean Paul Medina,&nbsp;Ruben Gianeri,&nbsp;Maria Grazia Bruzzone,&nbsp;Benjamin Becker,&nbsp;Alberto Proietti,&nbsp;Massimo Leone,&nbsp;Luisa Chiapparini,&nbsp;Stefania Ferraro,&nbsp;Anna Nigri","doi":"10.1177/03331024211058205","DOIUrl":"https://doi.org/10.1177/03331024211058205","url":null,"abstract":"<p><strong>Purpose: </strong>Previous studies on brain morphological alterations in chronic cluster headache revealed inconsistent findings.</p><p><strong>Method: </strong>The present cross-sectional explorative study determined telencephalic and cerebellar cortex thickness alterations in a relatively wide sample of chronic cluster headache patients (n = 28) comparing them to matched healthy individuals.</p><p><strong>Results: </strong>The combination of two highly robust state-of-the-art approaches for thickness estimation (Freesurfer, CERES), strengthened by functional characterization of the identified abnormal regions, revealed four main results: chronic cluster headache patients show 1) cortical thinning in the right middle cingulate cortex, left posterior insula, and anterior cerebellar lobe, regions involved in nociception's sensory and sensory-motor aspects and possibly in autonomic functions; 2) cortical thinning in the left anterior superior temporal sulcus and the left collateral/lingual sulcus, suggesting neuroplastic maladaptation in areas possibly involved in social cognition, which may promote psychiatric comorbidity; 3) abnormal functional connectivity among some of these identified telencephalic areas; 4) the identified telencephalic areas of cortical thinning present robust interaction, as indicated by the functional connectivity results, with the left posterior insula possibly playing a pivotal role.</p><p><strong>Conclusion: </strong>The reported results constitute a coherent and robust picture of the chronic cluster headache brain. Our study paves the way for hypothesis-driven studies that might impact our understanding of the pathophysiology of this condition.</p>","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"444-454"},"PeriodicalIF":4.9,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39701553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to retire 'New daily persistent headache': Mode of onset of chronic migraine and tension-type headache.","authors":"Rhannon Lobo,&nbsp;Mu Wang,&nbsp;Sean Lobo,&nbsp;Anish Bahra","doi":"10.1177/03331024211044440","DOIUrl":"https://doi.org/10.1177/03331024211044440","url":null,"abstract":"<p><p>New daily persistent headache is described as an enigmatic condition with daily headache from onset. It has posed challenges diagnostically and therapeutically.<b>Methods:</b> We conducted a study of patients referred to headache services based in Central and North-East London, United Kingdom, meeting the International Classificaiton of Headache Disorders - 3 criteria for New daily persistent headache. Information on demographics, phenotype and treatment responses were collected. The syndrome of the daily headache was also classified according any other ICHD-3-defined syndrome.<b>Results:</b> Of 162 patients, females comprised 68.5% with median age of onset 35 years. The daily headache experienced was chronic migraine in 89.7% and tension-type headache in 8.8%. Thunderclap-onset New daily persistent headache occurred in 14.8%. More than one headache syndrome was experienced in 15.4%, including cough, hypnic, sexual and stabbing headache. All aura types were experienced, most commonly brainstem aura in 39%. Prior headache was reported 53.7%. A persisting sub-form was present in 51.2%, relapsing remitting in 12.3% and 14.0% reported improvement; 19.8% were lost to follow-up. Only 11.1% reported an antecedent trigger. The most common premorbid disorders were psychiatric in 35.7%. A fifth improved on preventative medication, most commonly amitriptyline, propranolol and topiramate.<b>Conclusion:</b> Our cohort of New daily persistent headache is consistent with a mode of onset of migraine and tension-type headache which occurs in predisposed individuals.</p>","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"385-395"},"PeriodicalIF":4.9,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39463213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The characteristics of COVID-19 vaccine-related headache: Clues gathered from the healthcare personnel in the pandemic.","authors":"Esme Ekizoglu,&nbsp;Haşim Gezegen,&nbsp;Pınar Yalınay Dikmen,&nbsp;Elif Kocasoy Orhan,&nbsp;Mustafa Ertaş,&nbsp;Betül Baykan","doi":"10.1177/03331024211042390","DOIUrl":"https://doi.org/10.1177/03331024211042390","url":null,"abstract":"<p><strong>Introduction: </strong>Headache is a frequent adverse event after viral vaccines. We aimed to investigate the frequency and clinical associations of COVID-19 vaccine-related headache.</p><p><strong>Methods: </strong>The characteristics, associations of this headache, main comorbidities, headache history following the influenza vaccine and during COVID-19 were investigated using a web-based questionnaire.</p><p><strong>Results: </strong>A total of 1819 healthcare personnel (mean age: 44.4 ± 13.4 years, 1222 females), vaccinated with inactivated virus, contributed to the survey; 209 (11.4%) had been infected with COVID-19. A total of 556 participants (30.6%) reported headache with significant female dominance (36.1% vs. 19.3%), 1.8 ± 3.5 (median: 1; IQR: 0-2) days following vaccination. One hundred and forty-four participants (25.9%) experienced headache lasting ≥3 days. Headache was mostly bilateral without accompanying phenomena, less severe, and shorter than COVID-19-related headache. The presence of primary headaches and migraine were significantly associated with COVID-19 vaccine-related headache (ORs = 2.16 [95% CI 1.74-2.68] and 1.65 [1.24-2.19], respectively). Headache during COVID-19 or following influenza vaccine also showed significant association with headache following COVID-19 vaccine (OR = 4.3 [95% CI 1.82-10.2] and OR = 4.84 [95% CI 2.84-8.23], respectively). Only thyroid diseases showed a significant association (OR = 1.54 [95% CI 1.15-2.08]) with vaccine-related headache among the common comorbidities.</p><p><strong>Conclusion: </strong>Headache is observed in 30.6% of the healthcare workers following COVID-19 vaccine and mostly experienced by females with pre-existing primary headaches, thyroid disorders, headache during COVID-19, or headache related to the influenza vaccine.</p>","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"366-375"},"PeriodicalIF":4.9,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8988457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39407507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of exogenous beta-hydroxybutyrate for preventive treatment in episodic migraine: A single-centred, randomised, placebo-controlled, double-blind crossover trial.","authors":"Niveditha Putananickal,&nbsp;Elena C Gross,&nbsp;Anna-Lena Orsini,&nbsp;Simone Schmidt,&nbsp;Patricia Hafner,&nbsp;Vanya Gocheva,&nbsp;Sara Nagy,&nbsp;Bettina C Henzi,&nbsp;Daniela Rubino,&nbsp;Deborah R Vogt,&nbsp;Sven Cichon,&nbsp;Peter Sandor,&nbsp;Dirk Fischer","doi":"10.1177/03331024211043792","DOIUrl":"https://doi.org/10.1177/03331024211043792","url":null,"abstract":"<p><strong>Background: </strong>Several studies propose that brain energy deficit might be partially involved in the pathophysiology of migraine. Previously, studies demonstrated that ketogenic diet causes a substantial reduction in migraine frequency. Since the ketogenic diet is restricting and its adherence is difficult, we proposed to supplement ketone bodies exogenously to provide a prophylactic effect in migraineurs.</p><p><strong>Aim: </strong>To evaluate the prophylactic effect of exogenous DL-beta-hydroxybutyrate supplementation in episodic migraineurs.</p><p><strong>Methods: </strong>A double-blind, placebo-controlled, randomised crossover trial was conducted, involving 41 patients with episodic migraine. Patients were randomised 1:1 into placebo or beta-hydroxybutyrate group before entering the first treatment period. Each treatment period was 12 weeks long, followed by four weeks of washout phase and four weeks of run-in phase before entering into the corresponding second treatment period. The primary endpoint was the number of migraine days in the last four weeks of treatment, adjusted for baseline.</p><p><strong>Results: </strong>We observed no clinically significant amelioration of migraine frequency or intensity under DL-beta-hydroxybutyrate treatment as compared to placebo regarding number of migraine days (mean difference [95% CI]: -1.1[-5.07, 2.85]), migraine intensity (0-10 VAS: 1.5[-0.8, 3.7]).</p><p><strong>Conclusion: </strong>The selected dose of supplemented exogenous DL-beta-hydroxybutyrate did not demonstrate efficacy in episodic migraineurs.ClinicalTrials.gov Identifier: NCT03132233.</p>","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"302-311"},"PeriodicalIF":4.9,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39431552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of antibody switch in non-responders to a CGRP receptor antibody treatment in migraine: A multi-center retrospective cohort study.","authors":"Lucas Hendrik Overeem,&nbsp;Andreas Peikert,&nbsp;Maxi Dana Hofacker,&nbsp;Katharina Kamm,&nbsp;Ruth Ruscheweyh,&nbsp;Astrid Gendolla,&nbsp;Bianca Raffaelli,&nbsp;Uwe Reuter,&nbsp;Lars Neeb","doi":"10.1177/03331024211048765","DOIUrl":"https://doi.org/10.1177/03331024211048765","url":null,"abstract":"<p><strong>Background: </strong>Switching between antibody classes might be a treatment option in migraine patients who have not responded to one class of a CGRP-(receptor) monoclonal antibody (mAb), but there are no efficacy data so far. In this real-world analysis, we assessed the treatment response to a CGRP-mAb in patients that have previously failed the CGRP-receptor-mAb erenumab.</p><p><strong>Methods: </strong>We analyzed retrospective headache diary data of 78 patients with migraine who switched between CGRP-mAbs classes at four German headache centers either due to lack of efficacy or intolerable side effects. Among these, we identified 25 patients who did not respond to erenumab after three treatment cycles (defined as <30% reduction of monthly headache days) and had complete headache documentation at least one month before and during both treatments. We assessed the ≥30% responder rate at month three after switching from erenumab to a CGRP-mAb (galcanezumab or fremanezumab) (primary endpoint). Secondary endpoints included ≥50% responder rate, monthly headache days, and monthly days with acute medication use. In an exploratory subgroup analysis patients were stratified for daily and non-daily headache.</p><p><strong>Results: </strong>The switch from erenumab to a CGRP-mAb led to a ≥30% response in one-third (32%) of the patients after three treatment cycles. A ≥50% response was achieved in 12% of the patients. Monthly headache days were reduced in month three compared to baseline (20.8 ± 7.1 to 17.8 ± 9.1; p = 0.009). Stratified analysis revealed that no patient with daily headache (n = 9) responded to the treatment switch, while a 30% response was achieved by 50% of patients with non-daily headache (n = 16).</p><p><strong>Conclusion: </strong>Our findings demonstrate that a relevant proportion of erenumab non-responders might benefit from a treatment switch to a CGRP-mAb. Switching seems to be a promising treatment option especially in migraine patients with non-daily headache.</p>","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"291-301"},"PeriodicalIF":4.9,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8988456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39513935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}