Detoxification vs non-detoxification before starting an anti-CGRP monoclonal antibody in medication overuse headache.
Refractory migraine
calcitonin gene-related peptide
chronic migraine
drugs withdrawal
erenumab
galcanezumab
Journal
Cephalalgia : an international journal of headache
ISSN: 1468-2982
Titre abrégé: Cephalalgia
Pays: England
ID NLM: 8200710
Informations de publication
Date de publication:
06 2022
06 2022
Historique:
pubmed:
10
2
2022
medline:
18
5
2022
entrez:
9
2
2022
Statut:
ppublish
Résumé
Medication overuse headache significantly contributes to the chronification process and treatment refractoriness of migraine. Currently, abrupt discontinuation of the overused medication still represents the best management strategy for these patients, challenging public health system resources. In this prospective study, chronic migraine and medication overuse headache sufferers with at least 28 days of analgesic consumption per month were included. Assessment of efficacy outcomes at three months were compared among patients who underwent in-hospital abrupt discontinuation of overused acute medication (YES-DETOX group) and patients who did not (NO-DETOX group) before starting an anti-CGRP monoclonal antibody. Of 401 patients who received either erenumab or galcanezumab, 28% (n = 111) satisfied inclusion criteria (YES-DETOX n = 28; NO-DETOX n = 83). After three months of treatment, 59% (n = 65; 47/83 YES-DETOX; 18/28 NO-DETOX) patients reverted from medication overuse headache and 51% (n = 57; 42/83 YES-DETOX; 15/28 NO-DEOTX) achieved ≥50% reduction in monthly headache days; yet no statistical differences were observed between the two groups (p = 0.4788 and p = 0.8393, respectively). Monthly consumption of pain medication was the only baseline prognostic factor in multivariate analysis in the overall cohort (p = 0.016). Our results support the emerging evidence that anti-CGRP monoclonal antibodies may be effective in medication overuse headache patients irrespective of detoxification, yet further studies are needed to draw definitive conclusions.
Sections du résumé
BACKGROUND
Medication overuse headache significantly contributes to the chronification process and treatment refractoriness of migraine. Currently, abrupt discontinuation of the overused medication still represents the best management strategy for these patients, challenging public health system resources.
METHODS
In this prospective study, chronic migraine and medication overuse headache sufferers with at least 28 days of analgesic consumption per month were included. Assessment of efficacy outcomes at three months were compared among patients who underwent in-hospital abrupt discontinuation of overused acute medication (YES-DETOX group) and patients who did not (NO-DETOX group) before starting an anti-CGRP monoclonal antibody.
RESULTS
Of 401 patients who received either erenumab or galcanezumab, 28% (n = 111) satisfied inclusion criteria (YES-DETOX n = 28; NO-DETOX n = 83). After three months of treatment, 59% (n = 65; 47/83 YES-DETOX; 18/28 NO-DETOX) patients reverted from medication overuse headache and 51% (n = 57; 42/83 YES-DETOX; 15/28 NO-DEOTX) achieved ≥50% reduction in monthly headache days; yet no statistical differences were observed between the two groups (p = 0.4788 and p = 0.8393, respectively). Monthly consumption of pain medication was the only baseline prognostic factor in multivariate analysis in the overall cohort (p = 0.016).
CONCLUSION
Our results support the emerging evidence that anti-CGRP monoclonal antibodies may be effective in medication overuse headache patients irrespective of detoxification, yet further studies are needed to draw definitive conclusions.
Identifiants
pubmed: 35135357
doi: 10.1177/03331024211067791
pmc: PMC9109244
doi:
Substances chimiques
Antibodies, Monoclonal
0
Calcitonin Gene-Related Peptide Receptor Antagonists
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
645-653Références
Cephalalgia. 2018 Jan;38(1):1-211
pubmed: 29368949
CNS Drugs. 2021 May;35(5):545-565
pubmed: 34002347
Cephalalgia. 2016 Apr;36(4):371-86
pubmed: 26122645
Curr Pain Headache Rep. 2019 Jul 26;23(8):60
pubmed: 31346781
J Headache Pain. 2017 Dec;18(1):56
pubmed: 28500492
J Headache Pain. 2019 Oct 30;20(1):99
pubmed: 31666008
Brain. 2020 Sep 1;143(9):2681-2688
pubmed: 32810212
J Headache Pain. 2019 Jan 16;20(1):6
pubmed: 30651064
Neurol Sci. 2020 Dec;41(Suppl 2):457-459
pubmed: 32852684
Lancet Neurol. 2019 Sep;18(9):891-902
pubmed: 31174999
Nat Rev Neurol. 2016 Oct;12(10):575-83
pubmed: 27615418
Neurology. 2019 May 14;92(20):e2309-e2320
pubmed: 30996056
JAMA Neurol. 2020 Sep 1;77(9):1069-1078
pubmed: 32453406
Neurol Sci. 2021 Oct;42(10):4193-4202
pubmed: 33547541
Eur J Neurol. 2020 Jul;27(7):1102-1116
pubmed: 32430926
Neurol Sci. 2017 Nov;38(11):2025-2029
pubmed: 28879452
Eur J Neurol. 2020 Jan;27(1):62-e1
pubmed: 31291494
J Headache Pain. 2020 Sep 21;21(1):114
pubmed: 32958075
Cephalalgia. 2021 Mar;41(3):340-352
pubmed: 33143451
J Headache Pain. 2020 Jun 1;21(1):61
pubmed: 32487102
Front Neurol. 2020 May 28;11:417
pubmed: 32547474
Neurology. 2004 Apr 27;62(8):1338-42
pubmed: 15111671
Lancet Neurol. 2020 Sep;19(9):727-737
pubmed: 32822633
J Headache Pain. 2020 Jun 9;21(1):69
pubmed: 32517693
Neurol Sci. 2022 Feb;43(2):1273-1280
pubmed: 34224026
Eur J Neurol. 2012 May;19(5):703-11
pubmed: 22136117