Real-world clinical results of CGRP monoclonal antibody treatment for medication overuse headache of migraine without abrupt drug discontinuation and no hospitalization

Abstract

Abstract Background Abrupt discontinuation of overused medications is the gold standard treatment for medication overuse headache (MOH), but discontinuation is difficult to maintain. In this study, the aim was to evaluate the real-world clinical results of anti-calcitonin gene-related peptide monoclonal antibody (CGRP-mAb) treatment for MOH of migraine without abrupt drug discontinuation and no hospitalization. Methods Patients with MOH of migraine receiving naïve CGRP-mAb treatment without abrupt drug discontinuation were enrolled. Data were collected before starting CGRP-mAb injections (baseline) and after each injection. The primary endpoint was evaluated after the third injection. The following items were compared between baseline and after each injection: 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 (MHD and MMD, respectively) 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 MOH of migraine. After the third CGRP-mAb injection, MHD and MMD were significantly decreased from median 30.0 [interquartile range (IQR), 28.0–30.0] days to 9.5 [IQR, 5.5–13.3] days, and 10.0 [IQR, 6.0–15.0] days to 1.5 [IQR, 0.0–3.0] days, respectively (p < 0.001). In addition, monthly AMU days and tablets were also significantly decreased from median 28.0 [IQR, 20.0–30.0] days to 8.0 [IQR, 4.8–11.3] days, and 30.0 [IQR, 22.0–54.0] tablets to 9.5 [IQR, 4.8–13.5] tablets, respectively (p < 0.001). 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 (p < 0.001). Conclusions When CGRP-mAb was administered to MOH of migraine, the frequency of headache symptoms and AMU were reduced without abrupt drug discontinuation and no hospitalization.