Tanei Takafumi, Fuse Yutaro, Maesawa Satoshi, Nishimura Yusuke, Ishizaki Tomotaka, Nagashima Yoshitaka, Mutoh Manabu, Ito Yoshiki, Hashida Miki, Suzuki Takahiro, Yamamoto Syun, Wakabayashi Toshihiko, Saito Ryuta
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Department of Specialized Headache Outpatient, Nagoya Garden Clinic, Nagoya, Aichi, Japan.
Heliyon. 2024 Nov 6;10(22):e40190. doi: 10.1016/j.heliyon.2024.e40190. eCollection 2024 Nov 30.
Abrupt discontinuation of overused medications is standard treatment for medication overuse headache (MOH), but discontinuation is difficult to maintain. The aim was to evaluate the real-world clinical results of anti-calcitonin gene-related peptide monoclonal antibody (CGRP-mAb) treatment for migraine with MOH without abrupt drug discontinuation and no hospitalization.
Data were collected before starting CGRP-mAb injections (baseline) and 1 month after each injection. The following items were compared between baseline and after the first, second, and third CGRP-mAb injections, monthly headache days (MHD), monthly migraine days (MMD), monthly acute medication use (AMU) days, monthly total amount of AMU tablets, headache impact test-6 (HIT-6), and the migraine-specific quality of life questionnaire (MSQ). Achieving reduction rates ≥50 % in the frequency of each headache and migraine was defined as a good response. Achieving reduction rates of both AMU days and tablets ≥50 % was defined as effective in reducing AMU.
This study included 33 patients with migraine with MOH. After the third CGRP-mAb injection, MHD and MMD were significantly decreased from median 30.0 to 9.5 days, and 10.0 to 1.5 days, respectively. In addition, monthly AMU days and tablets were significantly decreased from median 28.0 to 8.0 days, and 30.0 to 9.5 tablets, respectively. After the third CGRP-mAb injection, the good MHD and MMD responder rates were 75.0 % and 85.7 %, respectively. The rate of reducing AMU was 78.6 %. HIT-6 and MSQ scores decreased significantly from baseline to after each CGRP-mAb injection.
When CGRP-mAb was administered to migraine with MOH, frequency of headache symptoms and AMU were reduced without abrupt drug discontinuation and no hospitalization.
突然停用过度使用的药物是药物过量使用性头痛（MOH）的标准治疗方法，但停药难以维持。目的是评估抗降钙素基因相关肽单克隆抗体（CGRP - mAb）治疗伴有MOH的偏头痛的真实世界临床效果，无需突然停药且无需住院。
在开始注射CGRP - mAb之前（基线）以及每次注射后1个月收集数据。比较基线与首次、第二次和第三次注射CGRP - mAb后的以下项目：每月头痛天数（MHD）、每月偏头痛天数（MMD）、每月急性药物使用（AMU）天数、每月AMU片剂总量、头痛影响测试 - 6（HIT - 6）以及偏头痛特异性生活质量问卷（MSQ）。每种头痛和偏头痛频率降低率≥50%被定义为良好反应。AMU天数和片剂减少率均≥50%被定义为在减少AMU方面有效。
本研究纳入了33例伴有MOH的偏头痛患者。第三次注射CGRP - mAb后，MHD和MMD分别从中位数30.0天显著降至9.5天和从10.0天降至1.5天。此外，每月AMU天数和片剂分别从中位数28.0天显著降至8.0天和从30.0片降至9.5片。第三次注射CGRP - mAb后，良好的MHD和MMD反应率分别为75.0%和85.7%。减少AMU的比率为78.6%。从基线到每次注射CGRP - mAb后，HIT - 6和MSQ评分均显著降低。
当将CGRP - mAb用于伴有MOH的偏头痛时，无需突然停药且无需住院即可降低头痛症状频率和AMU。
