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. 2022 Jun;42(7):645-653.
doi: 10.1177/03331024211067791. Epub 2022 Feb 9.

Detoxification vs non-detoxification before starting an anti-CGRP monoclonal antibody in medication overuse headache

Umberto Pensato  1 , Carlo Baraldi  2 , Valentina Favoni  3 , Davide Mascarella  1 , Eleonora Matteo  1 , Giorgia Andrini  1 , Maria Michela Cainazzo  2 , Pietro Cortelli  1   3 , Giulia Pierangeli  1   3 , Simona Guerzoni  2 , Sabina Cevoli  3
Affiliations

Detoxification vs non-detoxification before starting an anti-CGRP monoclonal antibody in medication overuse headache

Umberto Pensato et al. Cephalalgia. 2022 Jun.

Abstract

Background: Medication overuse headache significantly contributes to the chronification process and treatment refractoriness of migraine. Currently, abrupt discontinuation of the overused medication still represents the best management strategy for these patients, challenging public health system resources.

Methods: In this prospective study, chronic migraine and medication overuse headache sufferers with at least 28 days of analgesic consumption per month were included. Assessment of efficacy outcomes at three months were compared among patients who underwent in-hospital abrupt discontinuation of overused acute medication (YES-DETOX group) and patients who did not (NO-DETOX group) before starting an anti-CGRP monoclonal antibody.

Results: Of 401 patients who received either erenumab or galcanezumab, 28% (n = 111) satisfied inclusion criteria (YES-DETOX n = 28; NO-DETOX n = 83). After three months of treatment, 59% (n = 65; 47/83 YES-DETOX; 18/28 NO-DETOX) patients reverted from medication overuse headache and 51% (n = 57; 42/83 YES-DETOX; 15/28 NO-DEOTX) achieved ≥50% reduction in monthly headache days; yet no statistical differences were observed between the two groups (p = 0.4788 and p = 0.8393, respectively). Monthly consumption of pain medication was the only baseline prognostic factor in multivariate analysis in the overall cohort (p = 0.016).

Conclusion: Our results support the emerging evidence that anti-CGRP monoclonal antibodies may be effective in medication overuse headache patients irrespective of detoxification, yet further studies are needed to draw definitive conclusions.

Keywords: Refractory migraine; calcitonin gene-related peptide; chronic migraine; drugs withdrawal; erenumab; galcanezumab.

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Conflict of interest statement

Declaration of conflict of interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Carlo Baraldi and Simona Guerzoni received travel grants and honorary from Allergan, Novartis, Teva and Ely Lilly. Maria Michela Cainazzo received travel grants and honorary from Allergen, Novartis, IBSA and Ely Lilly. Sabina Cevoli and Giulia Pierangeli received travel grants, honoraria for advisory boards, speaker panels or clinical investigation studies from Novartis, Teva, Lilly, Allergan, Ibsa, and Lundbeck. Valentina Favoni received honoraria as a speaker or for participating in advisory boards from Ely-Lilly, Novartis and Teva. The other Authors declare that they have no competing interests.

Figures

Figure 1:
Figure 1:
Efficacy (MHD; MPMI) and disability (HIT-6; MIDAS) outcome measures at every injection. YES-DETOX group is shown in black lines, whereas NO-DETOX group is shown in red lines. MHD, monthly headache days; MPMI, monthly pain medication intake; HIT-6, 6 items headache impact test; MIDAS, migraine disability assessment score.
See this image and copyright information in PMC

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