Abstract text (incl. figure legends and references)

Question: We aimed at assessing the impact of monoclonal antibodies targeting the calcitonin gene-related peptide pathway (CGRP-mAbs) on migraine outcomes that are not usually captured by literature, including the optimization of acute treatments.
Methods: Consecutive patients with chronic or episodic migraine from the Headache Centers of Avezzano-L'Aquila and Naples, were included from March 2021 to June 2022. We included and followed up to 3 months patients starting treatment with any CGRP-mAb (erenumab, fremanezumab, or galcanezumab) at the baseline visit. All patients filled out the Migraine Treatment Optimization Questionnaire (MTOQ) at the start and 3 months after the start of treatment with CGRP-mAbs. During the study period, they completed a headache diary, where they reported the number of migraine days, and acute drug intakes.
Results: We included 41 patients, (87.5% women; 72.5% with chronic migraine), with a median age of 46 [interquartile range (IQR) 42.25–55] years. At baseline – i.e., during the 3 months before treatment start –, median MTOQ score was 6 (IQR 3-8), with 30 median monthly migraine days (IQR 20-53) and a median drugs intake equal to 30 doses (IQR 20.25-60). At the 3-month follow-up, median mTOQ scores increased to 10 (IQR 7-13; pvs. baseline), indicating better optimization of treatment during, while median monthly migraine days decreased to 20 (IQR 9-27.5; p=0.002 vs. baseline). The median number of acute treatment monthly doses decreased from 30 to 20 (IQR 5.75-29.25, p=0.010 vs baseline), during the 3 months of follow-up. Finally, higher scores on the mTOQ negatively correlated with lower use of acute treatments (p=0.028).
Conclusion: Our study shows that, 3 months of preventive treatment with CGRP-MoAbs led to a significant increase in mTOQ scores, meaning improved effectiveness of acute treatments, paralleled by decreased monthly migraine days and acute treatment use.