American Headache Society Annual Meeting
American Headache Society Annual Meeting
Source/Disclosures
Source:

Cohen F, et al. Abstract #825289. Presented at: American Headache Society Annual Meeting; June 15-30, 2020; Virtual.

Disclosures: Cohen reports no relevant financial disclosures.
June 16, 2020
2 min read
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Combined treatment significantly reduces migraine headache days

Source/Disclosures
Source:

Cohen F, et al. Abstract #825289. Presented at: American Headache Society Annual Meeting; June 15-30, 2020; Virtual.

Disclosures: Cohen reports no relevant financial disclosures.
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Treating patients who have chronic migraine with both onabotulinumtoxinA and calcitonin gene-related peptide monoclonal antibody medications could reduce their monthly migraine days by an additional 5.6 days than if they had just received onabotulinumtoxinA alone, according to research presented at the American Headache Society Annual Meeting.

“There’s only so many medications that have actually been evaluated specifically for chronic migraine, and those have included botox, the [calcitonin gene-related peptide (CGRP)] monoclonal antibodies and topiramate,” Fred Cohen, MD, an internal medicine resident physician at the Montefiore Medical Center and Albert Einstein College of Medicine, told Healio Primary Care.

Reduction in migraine days with combined treatment
Reference: Cohen F, et al. Abstract #825289. Presented at: American Headache Society Annual Meeting; June 15-30, 2020; Virtual.

He explained that “a lot of headache providers will see that, and while having one of these medications has helped, patients are not yet at that quality of life that they’re looking for — they’ve got some improvement, but they still need further treatment to get further headache reductions.”

Cohen and colleagues conducted a retrospective chart review of 153 patients with chronic migraine who received onabotulinumatoxinA and CGRP monoclonal antibody medication to determine if treatment with both medications resulted in fewer headache days per month.

The average age of the patients was 47.1 years. Of these patients, 89 were on erenumab (Aimovig; Novartis, Amgen), 51 were on galcanezumab (Emgality, Eli Lilly) and 13 were on fremanezumab (Ajovy, Teva Pharmaceuticals). Sixty-six patients had quantitative data documented, with an average of 25.3 headache days per month.

Researchers found that after being treated with onabotulinumtoxinA, patients experienced an average decrease of 10.96 monthly headache days, a 43.3% reduction from baseline (95% CI, 9.2-12.6). However, they determined that these patients were continuing to experience, on average, 14.34 headache days each month.

Patients who were also treated with a CGRP monoclonal antibody medication had an additional decrease of 5.64 headache days each month, or an additional reduction of 22.3% from baseline compared with those taking onatulinumtoxinA alone (95% CI, 4.5-6.7).

These patients experienced 8.69 headache days each month, Cohen and colleagues found, and experienced a decrease of 16.6 headache days each month, or a 65.6% reduction from baseline (95% CI, 14.3-18.8).

Researchers identified reported side effects of CGRP monoclonal antibody treatments — including constipation, injection site reaction and fatigue — in 13 patients.

Cohen explained that the next research step is to conduct a prospective chart review to provide more uniform data and help avoid recall bias.

He stressed that “chronic migraine is a very debilitating disorder — one of the more severe headache conditions, where patients are getting migraines the majority of the month.”

Because there are more treatments evaluated for episodic migraine than for chronic migraine, Cohen explained, this study and others are needed because in order to “to close that gap, we have to get more information on treating chronic migraine.”