Impact of anti-CGRP monoclonal antibodies on migraine attack accompanying symptoms: A real-world evidence study

Migraine; Anti-CGRP monoclonal antibodies; PhonophobiaMigraña; Anticuerpos monoclonales anti-CGRP; FonofobiaMigranya; Anticossos monoclonals anti-CGRP; FonofòbiaBackground Clinical trials on anti-calcitonin gene-related peptide monoclonal antibodies poorly investigated their impact on migraine accompanying symptoms. Objective To evaluate the impact of basal accompanying symptoms on anti-CGRP monoclonal antibodies treatment response and their evolution after six months of treatment in migraine patients. Methods Patients with migraine diagnosis seen in the Headache Clinic and treated with erenumab, galcanezumab or fremanezumab were prospectively recruited. They completed a daily eDiary which provided data on headache frequency and the following accompanying symptoms of each day: photophobia, phonophobia, nausea, dizziness, and aura. Patients were classified as responders or non-responders based on 50% or greater reduction in headache days per month at month 6 (≥50% response rate). Accompanying symptoms ratios based on headache days per month were assessed per patient at baseline and after three and six months. Comparisons for basal characteristics, basal accompanying symptoms ratios and their evolution after six months between responders and non-responders were performed. Results One hundred and fifty-eight patients were included, 44% (69/158) showed ≥50% response rate after six months. A significant reduction in headache days per month in both groups was found at month 6 (−9.4 days/month in ≥50% response rate group; p < 0.001, −2.2 days/month in <50% response rate group; p = 0.004). Additionally, significant decreases in photophobia (−19.5%, p < 0.001), phonophobia (−12.1%, p = 0.010) and aura ratios (−25.1%, p = 0.008) were found in ≥50% response rate group. No statistically significant reductions were found in nausea and dizziness in any group since their reduction was correlated with the decrease in headache days per month. Higher photophobia ratios at baseline were predictive of an increased response between months 3 and 6 (Incidence Risk Ratio = 0.928, p = 0.040). Conclusions The days per month with photophobia, phonophobia and aura decreased at a higher rate than headache days per month after six months in the ≥50% response group. Higher photophobia ratios were associated with higher response rates between three and six months. It could indicate an involvement of peripheral CGRP in photophobia as well as a central modulation of migraine through these treatments which mainly act on the periphery

Quantifying sensory thresholds along the migraine cycle: An exploratory longitudinal study

Allodynia; Osmophobia; PhonophobiaAlodínia; Osmofòbia; FonofòbiaAlodinia; Osmofobia; FonofobiaBackground To date, a number of studies on migraine have cross-sectionally evaluated sensory sensitivity with aversion thresholds/scores along the migraine cycle, reporting a decreased tolerance to sensory stimuli in different sensory modalities. Our hypothesis was that patients with migraine would exhibit heightened sensitivity to sound, light, touch and smell on days where they reported greater headache intensity. Methods This is an exploratory, longitudinal study, carried out over the course of 27 days. Aversion thresholds or scores to sound, light, touch and smell were quantified in six patients with migraine (11.33 ± 6.53 headache days/month). Results Patients reported an increased sensitivity to light (padj = 0.0297), touch (padj = 0.0077), and smell (padj = 0.0201) on days with higher headache intensity. However, a greater sensitivity to sound on days with higher headache intensity was only reported when anxiety levels were high (padj = 1.4e−06). Interestingly, variable levels of tolerance to bothersome light over time can also influence the correlation between light sensitivity and headache intensity (padj = 1.4e−06). Conclusions Based on the present findings, future longitudinal studies evaluating sensory threshold changes along the migraine cycle in patients with migraine should account for the increased tolerance to bothersome light over time as well as the effect of anxiety on auditory sensitivity.The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: NI salary has been co-funded by the European Regional Development Fund (001-P-001682) under the framework of the FEDER Operative Programme for Catalunya 2014–2020, with €1,527,637.88. AMM salary has been partially financed by a predoctoral grant from the “Fundació Institut de Recerca Hospital Universitari Vall d’Hebron” (VHIR/BEQUESPREDOC/2020/MARTI). AVB salary has been partially financed by a Juan de la Cierva-Formación grant (FJC2018-036804-I) and Juan de la Cierva – Incorporación postdoctoral (IJC2020-043139-I) from the Spanish Ministry of Science and Innovation. EC salary has been funded by Río Hortega grant Acción Estratégica en Salud 2017–2020, instituto de Salud Carlos III (CM20/00217)

sj-pdf-1-cep-10.1177_03331024241230279 - Supplemental material for Quantifying sensory thresholds along the migraine cycle: An exploratory longitudinal study

Supplemental material, sj-pdf-1-cep-10.1177_03331024241230279 for Quantifying sensory thresholds along the migraine cycle: An exploratory longitudinal study by Nara Ikumi, Angela Marti-Marca, Anna de la Torre-Suñe, Xim Cerda-Company, Adrià Vilà-Balló, Victor J Gallardo, Edoardo Caronna, Alicia Alpuente and Patricia Pozo-Rosich in Cephalalgia</p