Anti­CGRP monoclonal antibodies in resistant migraine: preliminary real-world effectiveness and clinical predictors of response at two years.

BACKGROUND: Monoclonal antibodies targeting calcitonin gene-related peptide (anti-CGRP mAbs) have shown clinical effectiveness and safety in randomized clinical studies. However, long-term studies in clinical practice remain limited. AIM: To assess the long-term effectiveness, clinical predictors and safety of three anti-CGRP mAbs (erenumab, galcanezumab, fremanezumab) in resistant migraine patients. METHOD: A single-center retrospective study was conducted from December 2019 to June 2023 involving 120 resistant migraine patients who received at least a month of anti-CGRP mAbs treatment. Patients completed a headache diary that included monthly acute medication intake (MAM), monthly migraine days (MMD), adverse events as well as completed Patient-Reported Outcome questionnaires (MIDAS [Migraine Disability Assessment] and Headache Impact Test 6 [HIT-6]). The number of patients achieving a ≥ 50% reduction in monthly migraine days was determined and classified as ≥ 50% responders, and baseline parameters and logistic regression between responders and non-responders were analyzed to identify potential predictors of response. Adverse events were registered in every follow-up. RESULTS: Treatment with anti-CGRP mAbs led to reductions in MIDAS, HIT-6, MMD and MAM from baseline to 6-24 months. At 6-12 months, responders (61% and 57%, respectively) exhibited lower baseline MMD and MAM. Medication overuse  was associated with non-responders from 6 to 24 months and it was identified as a negative predictor of treatment effectiveness (OR 0.23, 95% CI 0.07-0.74; p = 0.014). CONCLUSION: Anti-CGRP mAbs prove effectiveness and safety over a 24-month period in a RM population. Patients with no medication overuse and lower basal MMDs and MAM may respond better to anti-CGRP mAbs.

[Migraine as predictive factor of the presence of atrial septum aneurysm in patients with stroke and patent foramen ovale]. / Migraña como factor predictor de la presencia de aneurisma del septo auricular en pacientes con ictus y foramen oval permeable.

INTRODUCTION: Ischemic stroke in young patients is associated in up to 30% of cases to a patent foramen ovale (PFO) with or without atrial septum aneurism (ASA). Besides, a frequent association between migraine and PFO has been described, but few studies have addressed the possible association between ASA and migraine in stroke patients. METHODS: Observational study with inclusion of consecutive ischemic stroke patients in a Stroke Unit Data Bank of the Department of Neurology of a university hospital admitted between January 1994 and December 2005. Those patients who underwent transesophageal echocardiography (TEE) were selected and classified in two groups regarding the history of previous migraine. Logistic regression analysis models were developed to assess the risk of the combination of PFO and ASA in patients with migraine. RESULTS: 631 stroke patients with TEE were included. PFO was present in 61 patients (9.7%), isolated ASA in 34 (5.4%) and both abnormalities in 22 (3.49%). Patients with migraine and PFO had higher frequency of ASA than those with PFO and no migraine (75 vs 30.2%), and the relative risk to carry double interatrial septal abnormalities was 2.5 (95% confidence interval: 1.4-4.4). In the subgroup of patients under 55 years old, migraine history was associated to a nine-folder relative risk of carrying this combination, independently of age or gender. CONCLUSIONS: In patients with ischemic stroke and PFO the probability of having ASA could be higher in migrainous. This finding could have diagnostic implications, suggesting the convenience to seek for this association in these patients.

[Pseudomigraine with cerebrospinal fluid pleocytosis or syndrome of headache, temporary neurological deficit and cerebrospinal fluid. A historical review]. / Pseudomigraña con pleocitosis en el líquido cefalorraquídeo o síndrome de cefalea y déficit neurológicos transitorios con pleocitosis en el líquido cefalorraquídeo. Revisión histórica.

INTRODUCTION: The pseudomigraine syndrome with cerebrospinal fluid (CSF) and pleocytosis (PMP) or headache with neurologic deficits and CSF lymphocytosis (HaNDL) is an entity that they have been realized multiple contributions to their etiophysiopathology in the 25 years of their discovery. DEVELOPMENT: The PMP is described in 1980 by Swanson, Bartleson and Whisnant, and parallelly for Marti-Masso, and from then on there have been contributions of new cases, ones some atypical for mild headache, prolonged recurrence, symptomatic intracranial hypertension or infections for citomegalovirus that simulates PMP. They have carried out several approaches diagnoses along the years being established at the moment in the year 2004 by the International Classification of Headache Disorders. They have carried out contributions to their knowledge thanks to the realization of electroencephalograms, single photon emission computed tomography brain imaging, transcranial Doppler, evoked potentials, brain magnetic resonance imaging diffusion... giving place to the existence of numerous theories like the infectious-autoimmune, dysfunction of the blood brain barrier, spread cortical depression, trigeminous-vascular activation. CONCLUSIONS: The PMP or HaNDL is a benign entity with even unknown etiophysiopathology and where it is important the differential diagnosis with other entities potentially more dangerous.