Effectiveness and Safety of CGRP-mAbs in Menstrual-Related Migraine: A Real-World Experience

Introduction Migraine shows a significantly higher prevalence in women, especially during reproductive age when menstrual-related hormonal fluctuations represent the most common migraine trigger. Indeed, over 50% of patients report a higher occurrence of migraine attacks during the perimenstrual win...

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Bibliographic Details
Published in:Pain and therapy 2021-12, Vol.10 (2), p.1203-1214
Main Authors: Silvestro, Marcello, Orologio, Ilaria, Bonavita, Simona, Scotto di Clemente, Fabrizio, Fasano, Carla, Tessitore, Alessandro, Tedeschi, Gioacchino, Russo, Antonio
Format: Article
Language:English
Subjects:
Internal Medicine
Medicine
Medicine & Public Health
Original Research
Pain Medicine
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Summary:Introduction Migraine shows a significantly higher prevalence in women, especially during reproductive age when menstrual-related hormonal fluctuations represent the most common migraine trigger. Indeed, over 50% of patients report a higher occurrence of migraine attacks during the perimenstrual window. Menstrual migraine attacks are consistently referred to as more disabling, less responsive to symptomatic treatments, longer in duration, and more prone to relapse than non-menstrual migraine attacks. Evidence strongly suggests that estrogen fluctuations are involved in migraine attacks worsening during the perimenstrual window through several mechanisms directly or indirectly involving the CGRP pathway. We aimed to evaluate whether mAbs blocking CGRP-ligand or receptor (CGRP-mAbs) could represent an effective and safe preventive treatment for menstrual migraine attacks in patients with menstrual-related migraine (MRM) with previous treatment failures. Methods Forty patients with MRM with at least three previous treatment failures received monthly CGRP-mAbs. At the baseline and after six CGRP-mAbs administrations, patients underwent to extensive interviews to assess frequency, duration, intensity, and responsiveness to painkiller intake of migraine attacks occurring during the perimenstrual window. Results After six administrations of CGRP-mAbs we observed a reduction of median menstrual migraine frequency (from 5 to 2 days per month), pain intensity (from 8/10 to 6/10), and attacks duration (from 24 to 8 h) ( p  
ISSN:2193-8237
2193-651X
DOI:10.1007/s40122-021-00273-w