Real-world clinical results of CGRP monoclonal antibody treatment for medication overuse headache of migraine without abrupt drug discontinuation and no hospitalization
Takafumi Tanei,
Yutaro Fuse,
Satoshi Maesawa,
Yusuke Nishimura,
Tomotaka Ishizaki,
Yoshitaka Nagashima,
Manabu Mutoh,
Yoshiki Ito,
Miki Hashida,
Takahiro Suzuki,
Syun Yamamoto,
Toshihiko Wakabayashi,
Ryuta Saito
Affiliations
Takafumi Tanei
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Specialized Headache Outpatient, Nagoya Garden Clinic, Nagoya, Aichi, Japan; Corresponding author. Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
Yutaro Fuse
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Academia-Industry Collaboration Platform for Cultivating Medical AI Leaders (AI-MAILs), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
Satoshi Maesawa
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Neurosurgery, Nagoya Medical Center, Nagoya, Aichi, Japan
Yusuke Nishimura
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
Tomotaka Ishizaki
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
Yoshitaka Nagashima
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
Manabu Mutoh
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
Yoshiki Ito
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
Miki Hashida
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
Takahiro Suzuki
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
Syun Yamamoto
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
Toshihiko Wakabayashi
Department of Specialized Headache Outpatient, Nagoya Garden Clinic, Nagoya, Aichi, Japan
Ryuta Saito
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
Background: Abrupt discontinuation of overused medications is standard treatment for medication overuse headache (MOH), but discontinuation is difficult to maintain. The aim was to evaluate the real-world clinical results of anti-calcitonin gene-related peptide monoclonal antibody (CGRP-mAb) treatment for migraine with MOH without abrupt drug discontinuation and no hospitalization. Methods: Data were collected before starting CGRP-mAb injections (baseline) and 1 month after each injection. The following items were compared between baseline and after the first, second, and third CGRP-mAb injections, monthly headache days (MHD), monthly migraine days (MMD), monthly acute medication use (AMU) days, monthly total amount of AMU tablets, headache impact test-6 (HIT-6), and the migraine-specific quality of life questionnaire (MSQ). Achieving reduction rates ≥50 % in the frequency of each headache and migraine was defined as a good response. Achieving reduction rates of both AMU days and tablets ≥50 % was defined as effective in reducing AMU. Results: This study included 33 patients with migraine with MOH. After the third CGRP-mAb injection, MHD and MMD were significantly decreased from median 30.0 to 9.5 days, and 10.0 to 1.5 days, respectively. In addition, monthly AMU days and tablets were significantly decreased from median 28.0 to 8.0 days, and 30.0 to 9.5 tablets, respectively. After the third CGRP-mAb injection, the good MHD and MMD responder rates were 75.0 % and 85.7 %, respectively. The rate of reducing AMU was 78.6 %. HIT-6 and MSQ scores decreased significantly from baseline to after each CGRP-mAb injection. Conclusions: When CGRP-mAb was administered to migraine with MOH, frequency of headache symptoms and AMU were reduced without abrupt drug discontinuation and no hospitalization.
