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Background. Migraine is the second most incapacitating disease and is accompanied by multiple comorbidities, especially in chronic migraines. Migraine treatment and improvement of the patients’ quality of life are an important clinical issue. The calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) are the first target therapy for migraine. To date, there are no published data on the duration of effect after using mAbs. Aim. To determine the effect duration after cessation of erenumab treatment in patients with migraine. Methods. The study included 64 patients with migraine, who received at least three doses of erenumab; treatment was stopped when reduction of the headache frequency by at least 30% was achieved. The frequency of headache and migraine were assessed 1, 3 and 6 months after the end of treatment. Results. There was a significant increase in the frequency of headache compared to the values reported at the end of treatment, however, the rates were still significantly lower compared to the baseline values. In some patients, no increase in headache frequency following discontinuation of treatment was observed.

Background. Menstrual related migraine (MRM) occurs in 60% of women with migraine. These attacks are characterized by high intensity and poor response to abortive and prophylactic treatment. Hormonal therapy is one of the main treatment methods, but it has a large number of limitations. Increase in the CGRP level triggered by a decrease of estrogen levels is one of the basic mechanisms of MRM. It is of interest therefore to study the impact of anti-CGRP monoclonal antibodies (mAbs) in MRM. In addition, many patients have severe pelvic pain in the perimenstrual period (algodysmenorrhea). Algodysmenorrhea is associated with other chronic pain syndromes including migraine. Therefore, it is interesting to study the impact of anti-CGRP monoclonal antibodies on algodysmenorrhea. Material and methods. We recruited 64 women with migraine (episodic and chronic) over 18 years of age with regular menstrual cycle. 21 patients were diagnosed with MRM according to the International Classification of Headache Disorders, 3rd edition. Demographic data, migraine history, menstrual cycle characteristics and algodysmenorrhea symptoms were collected. Patients were treated with erenumab or fremanezumab for 3 months and followed up monthly with headache diaries. Results. After 3 months of treatment, the intensity of menstrual migraine attacks and algodysmenorrhea decreased by 50% or more (p=0,03* and p=0,045*, accordingly). There was a significant decrease in the total amount of headache days in MRM patients. Conclusion. Anti-CGRP mAbs are effective in MRM and algodysmenorrhea. Further studies are necessary.

The diagnosis of chronic migraine (CM) is made when there are 15 or more days of headache per month in a patient with migraine. Approximately 2.5% of patients with episodic migraine develop chronic migraine, which is more difficult to treat and often leads to drug-induced headache (LIH). Such patients are rarely included in clinical trials. Aim. To analyze in clinical practice the effectiveness of the CGRP monoclonal antibody erenumab after 6 months of therapy in patients with CM with and without LIHD, and to evaluate possible predictors of the effectiveness of prophylactic therapy. Materials and methods. The study included 47 patients with CM taking erenumab at a dose of 70 mg monthly for at least 3 months. Patients completed a headache diary throughout the study. The 12-item Allodynia Symptom Checklist (ACS-12) was used to assess the presence of allodynia. After 6 months of therapy, the efficacy and safety of treatment, the presence of LAH and possible predictors of efficacy were evaluated. Results. After 6 months of therapy, 22 (78.6%) patients no longer met the criteria for LIHD. The factors that positively influenced the outcome of therapy were the absence of allodynia (p0.05), the presence of photo- and phonophobia, and the one-sidedness of pain (p0.05). The age and number of days with headache in patients with HM before treatment did not have a statistically significant effect on the effect of therapy. The presence of LIHD did not statistically significantly affect the outcome of therapy. Conclusion. CGRP monoclonal antibodies are reasonable in patients with LIHD. The presence of LIHD does not affect the efficacy of erenumab prophylactic therapy, the presence of allodynia may be a predictor of failure, and the unilaterality of pain and irritability to light and sound indicate likely efficacy. Real-world studies with a large cohort of patients and longer durations of therapy are required to confirm these results.

Introduction. Migraine is one of the most common disabling neurological disorders. Recently developed monoclonal antibodies to calcitonin gene-related peptide (CGRP) or its receptor are the first targeted medication for preventive therapy of both episodic and chronic migraine. They have been thoroughly investigated in clinical trials; however, there is little data from real-world clinical practice available to date. The aim of this study is to assess the efficacy and safety of 6 months of treatment with erenumab in real-world clinical practice and investigate the effect of the drug on the patients’ sensitivity to medicines for migraine headaches relief and patient satisfaction after treatment.Materials and methods. Our observational cohort prospective study included patients in our Headache Clinic prescribed monoclonal antibodies blocking the CGRP-receptor – erenumab. During the investigation, we evaluated the previous preventive therapy and its efficacy, the number of days with migraine per month, adverse events occurring during the erenumab treatment, depression and anxiety (HADS), migraine disability (MIDAS), the presence of allodynia (ACS-12) and improved response to acute therapy after treatment. A total of 42 patients participated in the study: 6 men, 36 women, the average age was 43.9 ± 12.2. Of them, 38 patients (90%) had chronic migraine. Thirty-two patients (76%) had previously been prescribed preventive therapy, which proved ineffective, and 10 patients (24%) had not once received any type of migraine prevention.Results. Among our patients, we identified 11 patients with resistant migraine and one patient with refractory migraine. During the study, two patients dropped out due to adverse events (constipation). Thirty patients continued the administration of erenumab 70 mg for at least six months. The average number of migraine days per month before treatment was 22.8, and after six months of treatment, it dropped to 7.3. Twenty-nine patients (72.5%) also noted that the response to acute headache treatment improved after the therapy.Conclusion. The results of our study are consistent with the international experience of using erenumab and confirm its effectiveness for migraine preventive therapy, including difficult-to-treat migraine cases. However, further studies with more participants and evaluation of predictors of successful monoclonal antibody therapy are still needed.

Objective: To assess the effectiveness and safety of Erenumab, a monoclonal antibody to calcitonin gene-related peptide receptors, in patients with high-frequency episodic migraine (HFEM) in real-life study., Material and Methods: 35 patients with HFEM without aura (≥8-14 attacks per month) (30 females, mean age 32.4±8.1) received monthly subcutaneous administration of Erenumab 70 mg for 3 months. The primary endpoint was the change in monthly migraine days (MMDs) from baseline, the secondary endpoint was the proportion of patients who achieved a 50% reduction in the number of days with headache. The change in pain intensity, change in the number of days of use of acute migraine-specific medication, the effect on daily activity (HIT-6 scale, MIDAS), anxiety and depression (the Hospital Anxiety and Depression Scale) were assessed., Results: At the end of the third month Erenumab decreased MMDs by 5±3.6 ( p =0.00000). A 50% reduction in the mean number of migraine days per month was achieved for 60% of patients, the intensity of headache according to the visual analogue scale from 8±1.2 points to 5±2 points ( p =0.00000), monthly analgesics intake passed from 11±7 to 4.5±3.7 ( p =0.000001). 25.7% of patients did not respond to treatment, showing less than a 30% decrease in the number of days with headache. A decrease in pain intensity correlated with a decrease in anxiety (from 8±4 to 6±4 points ( p =0.003)) and depression (from 6±4 to 4±3 points ( p =0.0004)) according to HADS, reduced HIT-6 scale from 65±6 to 55±7 points ( p =0.00000) and MIDAS from 45 [33; 67] points to 16 [5; 33] ( p =0.000004)). Patients reported good tolerability of Erenumab. 25.7% of patients noted a tendency to constipation. No patient discontinued treatment due to adverse events., Conclusion: Real-life study confirmed the efficacy and safety of Erenumab in the treatment of HFEM, a decrease in the severity of comorbid anxiety and depression, and social maladjustment.

Objective: To assess the effectiveness and safety of erenumab in real-life study., Material and Methods: 33 patients with episodic and chronic migraine (30 females, mean age 39.2±9.2, 3 males, mean age - 49.3±7.6) received erenumab 70 mg for each 3 months. Patients achieved a 50% reduction in the number of days with headache, pain intensity, duration, the number of days of acute medication use, effect on daily activity (HIT-6), side effects, neuropsychological testing (Beck Depression scale, Spielberger-Khanin questionnaire, Hospital Depression and Anxiety Scale) were assessed., Results: During the first month of therapy, a 50% decrease in headache days was observed in 48% of patients, during the second - in 53% of patients, during the third - in 51.5% of patients ( p <0.001), a reduce in pain intensity, HIT-6 score, duration of migraine attack was observed ( p <0.005). A decrease in situational anxiety was revealed (Spielberger-Khanin questionnaire, p =0.02), but not depression. There was a decrease in the consumption of triptans ( p <0.0005) and other analgesics ( p =0.0018). 1 patient noted transient constipation., Conclusion: The effectiveness and safety of erenumab in the outpatient practice is shown.