Effect of Galcanezumab in Migraine and Concomitant Medication Overuse Headache Without Prior Drug Withdrawal

Abstract text (incl. figure legends and references)
Introduction- Medication overuse headache (MOH) is a disabling and usual comorbidity in migraine patients. We aim to evaluate the effect of Galcanezumab (anti-CGRP monoclonal antibody) in migraine patients with concomitant MOH without prior drug withdrawal. Methods- Prospective observational study of migraine and MOH patients treated with Galcanezumab in the Headache Unit of a tertiary hospital. Patients received education about MOH, but no detoxification was performed prior to starting therapy. The evaluated outcomes were: monthly headache days (MHD), reduction of symptomatic medication and disability associated with migraine (HIT6 and MIDAS) after 3, 6 and 12 months. Results- 74 patients were treated with Galcanezumab for at least 6 months. The drug was discontinued in 5/74 (6.8%) due to lack of effect. 53/74 (71.6%) completed 12 months of treatment. The responder rate was 64.7%. Baseline median (p25-75) MHD was 20.9 (14.0-30.0), reduced to 7.0 (4.0-15.0) at 3 months, 6.0 (3.0-12.5) at 6 months, and 10.0 (3.5-15.0) in 12 months. Monthly NSAID consumption decreased from 15.5 (1.5-30.5) to 4.0 (0.0-10.0) at 3 months, to 3.0 (0.0-7.0) at 6 months, and to 4.0 (0.0-14.0) at 12 months. Monthly triptan use decreased from 14.0 (8.0-20.0) to 4.0 (0.0-8.0) at 3 months, to 4.5 (2.0-9.8) at 6 months, and to 5.0 (1.5-10.0) at 12 months. Likewise, a reduction in MIDAS and HIT6 was recorded. All these differences were statistically significant (p<0.001). Conclusion- Galcanezumab is a valid therapeutic option in migraine patients with comorbid MOH, being able to decrease headache burden, drug intake and disability without prior drug withdrawal.