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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 wi...

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Autores principales: Silvestro, Marcello, Orologio, Ilaria, Bonavita, Simona, Scotto di Clemente, Fabrizio, Fasano, Carla, Tessitore, Alessandro, Tedeschi, Gioacchino, Russo, Antonio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Healthcare 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8586402/
https://www.ncbi.nlm.nih.gov/pubmed/34106431
http://dx.doi.org/10.1007/s40122-021-00273-w
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author Silvestro, Marcello
Orologio, Ilaria
Bonavita, Simona
Scotto di Clemente, Fabrizio
Fasano, Carla
Tessitore, Alessandro
Tedeschi, Gioacchino
Russo, Antonio
author_facet Silvestro, Marcello
Orologio, Ilaria
Bonavita, Simona
Scotto di Clemente, Fabrizio
Fasano, Carla
Tessitore, Alessandro
Tedeschi, Gioacchino
Russo, Antonio
author_sort Silvestro, Marcello
collection PubMed
description 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 < 0.001). Nevertheless, a significant increase in the percentage of responding to migraine painkillers was observed from 42.5% at baseline to 95% at T1 (p < 0.001). CONCLUSIONS: CGRP-mAbs could represent a safe and effective preventive therapeutic strategy able to reduce the disabling burden of menstrual migraine attack frequency, duration, intensity, and significantly improve the response to painkillers. These findings could be related to and further indirectly prove the greater influence of CGRP-mediated mechanisms in the pathophysiology of menstrual migraine attacks. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40122-021-00273-w.
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spelling pubmed-85864022021-11-23 Effectiveness and Safety of CGRP-mAbs in Menstrual-Related Migraine: A Real-World Experience Silvestro, Marcello Orologio, Ilaria Bonavita, Simona Scotto di Clemente, Fabrizio Fasano, Carla Tessitore, Alessandro Tedeschi, Gioacchino Russo, Antonio Pain Ther Original Research 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 < 0.001). Nevertheless, a significant increase in the percentage of responding to migraine painkillers was observed from 42.5% at baseline to 95% at T1 (p < 0.001). CONCLUSIONS: CGRP-mAbs could represent a safe and effective preventive therapeutic strategy able to reduce the disabling burden of menstrual migraine attack frequency, duration, intensity, and significantly improve the response to painkillers. These findings could be related to and further indirectly prove the greater influence of CGRP-mediated mechanisms in the pathophysiology of menstrual migraine attacks. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40122-021-00273-w. Springer Healthcare 2021-06-09 2021-12 /pmc/articles/PMC8586402/ /pubmed/34106431 http://dx.doi.org/10.1007/s40122-021-00273-w Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc/4.0/Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Silvestro, Marcello
Orologio, Ilaria
Bonavita, Simona
Scotto di Clemente, Fabrizio
Fasano, Carla
Tessitore, Alessandro
Tedeschi, Gioacchino
Russo, Antonio
Effectiveness and Safety of CGRP-mAbs in Menstrual-Related Migraine: A Real-World Experience
title Effectiveness and Safety of CGRP-mAbs in Menstrual-Related Migraine: A Real-World Experience
title_full Effectiveness and Safety of CGRP-mAbs in Menstrual-Related Migraine: A Real-World Experience
title_fullStr Effectiveness and Safety of CGRP-mAbs in Menstrual-Related Migraine: A Real-World Experience
title_full_unstemmed Effectiveness and Safety of CGRP-mAbs in Menstrual-Related Migraine: A Real-World Experience
title_short Effectiveness and Safety of CGRP-mAbs in Menstrual-Related Migraine: A Real-World Experience
title_sort effectiveness and safety of cgrp-mabs in menstrual-related migraine: a real-world experience
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8586402/
https://www.ncbi.nlm.nih.gov/pubmed/34106431
http://dx.doi.org/10.1007/s40122-021-00273-w
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