Real-life assessment of erenumab in refractory chronic migraine with medication overuse headache

Objective To determine whether erenumab is effective and safe in refractory chronic migraine with medication overuse headache. Methods In this prospective, multicentric, real-life study, chronic migraine with medication overuse headache patients who received erenumab were recruited. Study inclusion was limited to patients who previously failed onabotulinumtoxinA in addition to at least three other pharmacological commonly used migraine preventive medication classes. Results Of 396 patients who received erenumab, 38% (n = 149) met inclusion criteria. After 3 months, 51% (n = 76) and 20% (n = 30) patients achieved >= 50% and >= 75% reduction in monthly headache days, respectively. Monthly pain medications intake decreased from 46.1 +/- 35.3 to 16.8 +/- 13.9 (p < 0.001), while monthly headache days decreased from 25.4 +/- 5.4 to 14.1 +/- 8.6 (p < 0.001). Increasing efficacy of erenumab over the study period was observed. Allodynia was a negative predictive factor of erenumab response (odds ratio = 0.47; p = 0.03). Clinical conversion to episodic migraine with no medication overuse was observed in 64% (n = 96) patients. No serious adverse events were observed. Conclusions Erenumab reduced significantly migraine frequency and pain medication intake in refractory chronic migraine with MOH patients.

Automated summary

The study found that erenumab significantly reduced migraine frequency and pain medication intake in refractory chronic migraine patients with medication overuse headache. After 3 months, 51% of patients experienced a reduction of at least 50% in monthly headache days, with 20% experiencing a reduction of at least 75%. Allodynia was identified as a negative predictive factor for erenumab response, while 64% of patients clinically converted to episodic migraine without medication overuse.