Migraine evolution after the cessation of CGRP(-receptor) antibody prophylaxis: a prospective, longitudinal cohort study

Background National and international guidelines recommend stopping migraine prophylaxis with CGRP(-receptor) monoclonal antibodies after 6-12 months of successful therapy. In this study, we aimed to analyze the course of migraine for four months after the cessation of CGRP(-receptor) antibodies use. Methods This longitudinal cohort study included patients with migraine who received a CGRP-(receptor) antibody for >= 8 months before treatment cessation. We analyzed headache data in the four-week period prior to mAb treatment initiation (baseline), in the month before the last mAb injection, in weeks 5-8 and 13-16 after last treatment. Primary endpoint of the study was the change of monthly migraine days from the month before last treatment to weeks 13-16. Secondary endpoints were changes in monthly headache days and monthly days with acute medication use. Results A total of 62 patients equally distributed between prophylaxis with the CGRP-receptor antibody erenumab and the CGRP antibodies galcanezumab or fremanezumab participated in the study. Patients reported 8.2 +/- 6.6 monthly migraine days in the month before last treatment. Monthly migraine days gradually increased to 10.3 +/- 6.8 in weeks 5-8 (p = 0.001) and to 12.5 +/- 6.6 in weeks 13-16 (p < 0.001) after drug cessation. Monthly migraine days in weeks 13-16 were not different from baseline values (-0.8 +/- 5.4; p > 0.999). Monthly headache days and monthly days with acute medication use showed a similar pattern. Conclusions The cessation of CGRP(-receptor) antibodies migraine prophylaxis was associated with a significant increase of migraine frequency and acute medication intake over time.

Automated summary

The cessation of CGRP(-receptor) antibodies migraine prophylaxis led to a significant increase in migraine frequency and acute medication intake over time. However, by weeks 13-16, the monthly migraine days were not significantly different from baseline values.