Impact of migraine attack accompanying symptoms in treatment response to anti-CGRP monoclonal antibodies treatment and their evolution after 6 months

Abstract text (incl. figure legends and references)

Question: Studies with anti-CGRP monoclonal antibodies (mAbs) poorly investigated their impact on migraine accompanying symptoms. We aimed to evaluate whether accompanying symptoms at baseline influenced mAb treatment response and their evolution after 6 months.

Methods: Prospective study. Patients with migraine diagnosis seen in the Headache Clinic and treated with erenumab, galcanezumab or fremanezumab were recruited. They completed a daily electronic diary providing data on migraine frequency and accompanying symptoms in every attack (photophobia, phonophobia, nausea, dizziness and aura). Patients were classified as responders or non-responders based on 50% or greater reduction in HDM at 6 months (≥50% RR). Accompanying symptoms ratios based on headache days per month (HDM) were assessed per patient at baseline and after 6 months. Comparisons for baseline characteristics, for accompanying symptoms ratios between responders and non-responders and for symptomatology between baseline and 6 months were performed. A generalized Poisson mixed-effects regression model was estimated to assess the potential effect of accompanying symptoms at baseline on HDM evolution.

Results: 106 patients were included, 48/106 (45%) had ≥50% RR. No statistically significant differences in accompanying symptoms at baseline were found between groups. A significant reduction in HDM in both groups after 6 months was found (-11.0 days/month responders,-3.2 days/month non-responders;p<0.001). Significant decreases in photophobia (-16.0%,p=0.008) and phonophobia ratios (-10.6%,p=0.037) were additionally found for responders. Accompanying symptoms at baseline did not reach a significant effect on HDM reduction over time.

Conclusions: Photophobia and phonophobia ratios based on HDM were significantly reduced in the responder group, indicating that the presence of these accompanying symptoms improve due to mAbs treatment and decrease to a higher rate than HDM does for responders after 6 months.