Headache Center, L. Sacco University Hospital, Milan, Italy.
School of Medicine and Surgery, University of Monza, Monza, Italy.
Neurol Sci. 2022 Sep;43(9):5765-5767. doi: 10.1007/s10072-022-06251-0. Epub 2022 Jul 16.
Anti-CGRP monoclonal antibodies (CGRPmAbs) enlarged migraine prevention options. They work targetedly, safely, and efficiently in many patients. Inexplicably, a proportion of patients show scarce improvement.
To identify the possible role of personality traits, determined with the Personality Inventory for DSM5 (PID5), on the efficacy of CGRPmAbs on migraine.
We evaluated 3 parameters: monthly headache days (MHD), monthly painkillers intake (MPI), and MIDAS. For each parameter, patients were classified as: (A) non-responders (reduction < 3 0% vs. baseline); (B) partial responders (30-49% reduction); (C) full responders (reduction > 50%).
Ninety-seven patients treated with CGRP-mAbs were included (33 galcanezumab, 13 fremanezumab, 51 erenumab). Considering attack reduction (MHD), 53 (54.6%) were full responders, 13 (13.4%) partial responders, and 31 (32%) non-responders. Considering MPI, 61 (62.9%) were full responders, 11 (11.3%) partial responders, and 24 (24.7%) non-responders. Concerning MIDAS, 53 (53%) were full responders, 17 (17.5%) partial responders, and 21 (21.6%) were non-responders. All the 97 patients were tested with the PID5. In terms of MHDs, non-responders, in comparison with responders, showed a significant excess of disinhibition, especially in relation with the anhedonia and depressivity facets. Concerning MPI, non-responders showed increased depressivity and distractibility. MIDAS non-responders had significantly higher scores in the antagonism domain and submissiveness facet.
Non-responders seem to have different personality traits in comparison to responders, with a higher tendency toward depressed mood and difficulty to feel pleasure previously found in migraineurs vs. non-migraineurs: the more strict certain traits are, the more difficult to treat the migraine could be.
抗降钙素基因相关肽单克隆抗体（CGRPmAb）扩大了偏头痛预防选择。它们在许多患者中靶向、安全且有效地发挥作用。但令人费解的是，一部分患者的改善效果甚微。
确定人格特质（通过 DSM5 人格量表 [PID5] 确定）在 CGRPmAb 对偏头痛的疗效中的可能作用。
我们评估了 3 个参数：每月头痛天数（MHD）、每月止痛药摄入量（MPI）和 MIDAS。对于每个参数，患者分为：（A）无反应者（与基线相比减少<30%）；（B）部分反应者（减少 30-49%）；（C）完全反应者（减少>50%）。
共纳入 97 例接受 CGRP-mAb 治疗的患者（33 例加奈珠单抗、13 例依那西普单抗、51 例埃替拉珠单抗）。考虑到发作减少（MHD），53 例（54.6%）为完全反应者，13 例（13.4%）为部分反应者，31 例（32%）为无反应者。考虑到 MPI，61 例（62.9%）为完全反应者，11 例（11.3%）为部分反应者，24 例（24.7%）为无反应者。在 MIDAS 方面，53 例（53%）为完全反应者，17 例（17.5%）为部分反应者，21 例（21.6%）为无反应者。97 例患者均接受了 PID5 测试。在 MHD 方面，与反应者相比，无反应者表现出明显的抑制过度，尤其是在快感缺乏和抑郁方面。关于 MPI，无反应者表现出更高的抑郁和注意力不集中。MIDAS 无反应者在对抗性和顺从性方面的得分明显较高。
与反应者相比，无反应者似乎具有不同的人格特征，表现出更高的抑郁情绪倾向和以前在偏头痛患者与非偏头痛患者中发现的难以感到愉悦的倾向：某些特征越严格，偏头痛的治疗就越困难。
