Background: Cluster headache (CH) and migraine are recurrent painful primary cephalalgies, typically with different clinical appearance and some shared features, such as unilateral pain, common triggers and response to triptans and/or monoclonal antibodies against the calcitonin gene-related peptide (CGRP) pathway. Common pathophysiological mechanisms are proposed in CH and migraine, including the role of the trigeminal-vascular system with its most representative neuropeptide, CGRP. Very few case series have been conducted so far investigating anti-CGRP treatments in patients with comorbid CH and migraine, and no cases have been reported which assess both CH and chronic migraine outcomes. Case series: We describe 4 patients with both chronic migraine and cluster headache, with or without failure to preventive medications. Galcanezumab (240 mg loading dose, followed by 120 mg monthly) was used for at least a 3-month treatment, demonstrating improvement in both migraine and CH outcomes (i.e. migraine days, CH attacks, Headache Impact Test -6 item score, acute medications use), achieving sustained clinical benefit. No adverse events were reported. Discussion and conclusion: Taking into account the role of CGRP in migraine and CH pathophysiology, a usually well-tolerated treatment with CGRP blockade could be a rationale-based option to treat patients with coexisting chronic migraine and cluster headache. Additional studies are needed to assess the role of anti-CGRP drugs in episodic and chronic CH treatment, as well as to establish correct timing and patient prerequisites to begin therapy.

Galcanezumab effectiveness on comorbid cluster headache and chronic migraine: a prospective case series / Iannone L.F.; Fattori D.; Geppetti P.; De Cesaris F.. - In: NEUROLOGICAL SCIENCES. - ISSN 1590-1874. - ELETTRONICO. - 43:(2022), pp. 697-703. [10.1007/s10072-021-05624-1]

Galcanezumab effectiveness on comorbid cluster headache and chronic migraine: a prospective case series

Iannone L. F.;Fattori D.;Geppetti P.;De Cesaris F.
2022

Abstract

Background: Cluster headache (CH) and migraine are recurrent painful primary cephalalgies, typically with different clinical appearance and some shared features, such as unilateral pain, common triggers and response to triptans and/or monoclonal antibodies against the calcitonin gene-related peptide (CGRP) pathway. Common pathophysiological mechanisms are proposed in CH and migraine, including the role of the trigeminal-vascular system with its most representative neuropeptide, CGRP. Very few case series have been conducted so far investigating anti-CGRP treatments in patients with comorbid CH and migraine, and no cases have been reported which assess both CH and chronic migraine outcomes. Case series: We describe 4 patients with both chronic migraine and cluster headache, with or without failure to preventive medications. Galcanezumab (240 mg loading dose, followed by 120 mg monthly) was used for at least a 3-month treatment, demonstrating improvement in both migraine and CH outcomes (i.e. migraine days, CH attacks, Headache Impact Test -6 item score, acute medications use), achieving sustained clinical benefit. No adverse events were reported. Discussion and conclusion: Taking into account the role of CGRP in migraine and CH pathophysiology, a usually well-tolerated treatment with CGRP blockade could be a rationale-based option to treat patients with coexisting chronic migraine and cluster headache. Additional studies are needed to assess the role of anti-CGRP drugs in episodic and chronic CH treatment, as well as to establish correct timing and patient prerequisites to begin therapy.
2022
43
697
703
Iannone L.F.; Fattori D.; Geppetti P.; De Cesaris F.
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1266138
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