Migraine Treatment Using Erenumab: Can Lead to a Cognitive and Psychological Qualitative Improvement?

Migraine is one of the most disabling disorders in the world, associated with poor quality of life. Migraine prevention strategies have increasingly evolved since monoclonal antibodies against the calcitonin gene-related peptide (CGRP), or its receptor, were identified. CGRP is the ideal target of monoclonal antibodies (mAbs). In particular, erenumab is the mAb that has shown good therapeutic efficacy in reducing pain intensity and having high tolerability. In this study, we aimed to investigate the efficacy of erenumab on both cognitive performance and psychological well-being. This was a pilot study with a retrospective design that included 14 subjects (2 males and 12 females), with a mean age of 52.29 ± 9.62, who attended the Headache and Migraine outpatient clinic of the IRCCS Centro Neurolesi Bonino-Pulejo of Messina. The evaluation consisted of measuring cognitive and psychological functioning. Comparing clinical and psychometric test scores between baseline and follow-up, we found a significant improvement in both cognitive performance and quality of life. We also observed a decrease in migraine disability. Our findings have shown improvements in global cognitive performance and quality of life in migraine patients taking erenumab.

Cognitive functions and psychological symptoms in migraine: a study on patients with and without aura.

AIM: Migraine is neurological disorder with a complex pathophysiology. We described the neuropsychological profile of 100 migraineurs (50 with visual aura and 50 without aura), in interictal phase, compared to 50 matched healthy controls. MATERIALS AND METHODS: A battery of standardized neuropsychological tests was used to assess attention, memory and executive functions. Beck Depression Inventory and Hamilton Rating Scale for Anxiety were used to evaluate anxiety and depressive symptoms. Severity of disability during daily activities was assessed by Migraine Disability Assessment. RESULTS: Migraine without aura showed a significant difference in comparison to healthy controls in semantic verbal fluency (p = 0.02), delayed memory (p < 0.001) and set-shifting (p < 0.001). Migraine with aura showed a significant difference in delayed memory (p = 0.001) and set-shifting (p = 0.005) if compared to healthy controls. No significant correlation between cognitive functions and mood was found (HAM-A p = 0.67) (BDI-II p = 0.42). CONCLUSIONS: Our data showed isolate and specific cognitive deficit during interictal phase in migraine patients. Future studies are need to identify if specific migraine characteristics may affect cognitive functions.

Functional connectivity and cognitive impairment in migraine with and without aura.

BACKGROUND: Several fMRI studies in migraine assessed resting state functional connectivity in different networks suggesting that this neurological condition was associated with brain functional alteration. The aim of present study was to explore the association between cognitive functions and cerebral functional connectivity, in default mode network, in migraine patients without and with aura, during interictal episodic attack. METHODS: Twenty-eight migraine patients (14 without and 14 with aura) and 14 matched normal controls, were consecutively recruited. A battery of standardized neuropsychological test was administered to evaluate cognitive functions and all subjects underwent a resting state with high field fMRI examination. RESULTS: Migraine patients did not show abnormalities in neuropsychological evaluation, while, we found a specific alteration in cortical network, if we compared migraine with and without aura. We observed, in migraine with aura, an increased connectivity in left angular gyrus, left supramarginal gyrus, right precentral gyrus, right postcentral gyrus, right insular cortex. CONCLUSION: Our findings showed in migraine patients an alteration in functional connectivity architecture. We think that our results could be useful to better understand migraine pathogenesis.

Erenumab and Possible CGRP Effect on Chronotype in Chronic Migraine: A Real-Life Study of 12 Months Treatment.

The introduction of monoclonal antibodies (mAbs) directed against the calcitonin gene-related peptide (CGRP), or its receptor (CGRPr), revolutionized migraine management due to their high efficacy and few side effects. Data suggest that the CGRP may even be implicated in circadian rhythm, but studies about the effect of anti-CGRP treatments on sleep are still lacking. The aim of the present study was to assess the effect of erenumab (70 and 140 mg per month), a human mAb directed against CGRPr, on chronotype in chronic migraineurs; secondly, we assessed its efficacy, safety, and the effects on anxiety and depression. Sleep was evaluated using self-administrable questionnaires investigating chronotype, sleep quality, and daytime sleepiness. Migraine diaries and several self-administrable questionnaires regarding headache impact and psychological correlates were evaluated every 3 months during 12 months of treatment. Eighty-eight patients were included; most of them showed a significant reduction in headache frequency and an improvement in psychological symptoms. Moreover, an initial change in chronotype was observed at the three-month assessment from a morning chronotype to an intermediate one; a similar trend remained in the other evaluations, even if it did not reach a statistical significance. Lastly, patients who responded to the treatment showed a progressive sleep efficiency reduction. The present real-life study hypothesized the influence of erenumab on chronotype, representing a link between circadian rhythm, CGRP, and migraine.

Mood and sleep problems in adolescents and young adults: an econometric analysis.

BACKGROUND: Sleep related problems affect approximately 25-40% of children and adolescents. The acquisition of sleep patterns characterised by later bedtimes, insomnia and excessive daytime sleepiness is related to poorer school performance, daytime drowsiness, physical tiredness and a higher rate of psychiatric illnesses. Many studies have investigated the correlation between sleep and mood in children and adolescents and overall, show a positive association between sleep problems and psychiatric disorders. However, little is known about adolescents' personal perception of their psychological status as it is linked with the occurrence of mood changes and sleep-related problems. AIMS OF THE STUDY: The aim of the study is to explore the impact of variables such as age, gender, education and the perception of their own psychological status (evaluated through suitable questionnaires) on the simultaneous presence of sleep disturbances and affective symptoms in a sample of adolescents. A positive correlation between these two dependent variables signals the need to intervene with proper support programs. METHODS: A recursive bivariate probit model has been employed. This method allows us to take into account two dependent dummy variables and to consider the relationship between the two, presuming that one may also influence the other. The analysis has been carried out on a sample of 2,005 adolescents out of a total of 4,000 who declared their willingness to be telephonically interviewed using a questionnaire in two parts designed to obtain information about the participants sleep habits and affective symptoms. RESULTS: There is a positive correlation between sadness and daytime drowsiness. The estimated joint probability ranging from 5.5% to 9% in girls demonstrates a greater tendency for girls to experience both depression and altered sleep patterns. DISCUSSION AND LIMITATIONS OF THE STUDY: Just as sadness is a key symptom of affective disorders, daytime drowsiness indicates the presence of sleep disorders caused by sleep habits that are likely to evolve into affective symptoms. This assumption is confirmed by the results of this analysis. However, since the interviews were conducted during the years 2003 and 2004, a replication of the analysis would outline whether this evidence is still the same or whether changes in habits and behaviours have intervened to modify substantially this pattern in recent years. As the analysis considers a sample of adolescents living in two southern Italian regions, the study should be replicated in other geographical areas. IMPLICATIONS FOR HEALTH CARE PROVISIONS AND USE: The early detection of affective symptoms in adolescents may presumably lead to a diminished use of antidepressants and an improvement in learning abilities and school results along with strengthening of personal motivations. IMPLICATIONS FOR HEALTH POLICIES: Counselling and educational programs directed towards those adolescents demonstrating poor sleep habits should be planned and implemented to avoid further complications and impact on their mental health.

Recurrent occipital seizures misdiagnosed as status migrainosus.

Periictal headache is commonly reported in patients with epilepsy and often exhibits migraine features. Misdiagnosis is frequent since visual seizures may often be misinterpreted as visual aura of migraine. We herein describe a 35-year-old woman with recurrent occipital seizures, clinically presenting with intractable headache. EEG monitoring was crucial in order to reach the correct diagnosis.

Construction of a telephone interview to assess the relationship between mood and sleep in adolescence.

Telephone interviews have been used extensively as a tool to explore and assess sleep disorders and psychopathological conditions. The aim of this study was to set up and validate a telephone interview aimed at assessing the correlation between mood and sleep variables in adolescents. The study included 16-18 years subjects. A total of approximately 4,000 calls were made; 529 adolescents were finally enrolled. The questionnaire was divided into two parts: the first one focused on affective variables, the second one explored sleep variables. A factorial analysis was carried out to explore the structure of the questionnaire according to two factors: the first, which we labeled "affective factor", and the second, "quality of sleep". A positive correlation was found regarding the feeling of wellbeing on awakening. A negative correlation was found between feeling of wellbeing on awakening and daytime drowsiness. In adolescence, increased daytime sleepiness seemed to correlate with worsening mood.

Effect of cognitive rehabilitation in a case of thalamic astrocytoma.

We describe the effectiveness of rehabilitative training for a neuropsychological deficit following the removal and treatment of a fibrillary astrocytoma (Grade II) in a young man. The rehabilitative training was based on cognitive and motivational techniques and has been carried out for a period of 3 months (2 times per week). The results, even if limited to a single case, seem to support the idea that cognitive rehabilitation should facilitate the brain's reorganization of basic cognitive functions in the neuro-oncologic field.

Ictal and interictal hypoactivation of the occipital cortex in migraine with aura. A neuroimaging and electrophysiological study.

In recent studies, several authors have highlighted and studied an altered blood oxygenation level dependent (BOLD) signal in subjects affected by migraine with aura, using functional magnetic resonance imaging (fMRI) during the migraine attack or during the period between two attacks. Using fMRI, we assessed a 27-year-old man affected by migraine with aura at two different times: during the migraine attack, and a fortnight later, in order to look for differences in regional cerebral blood flow after visual stimulation. In addition, during the attack-free period we carried out a series of electrophysiological examinations. Our results demonstrate different activation patterns of the occipital cortex during the asymptomatic period and during the migraine attack. Furthermore, the electrophysiological data obtained demonstrated altered activity due to the patient's disease.

Migraine with and without aura: electrophysiological and functional neuroimaging evidence.

The neuropathological processes believed to underlie migraine with and without aura are still widely debated in the literature. In order to arrive at a more detailed and comprehensive picture of the altered processes present in migraineurs, electrophysiological data obtained through transcranial magnetic stimulation (TMS) and electroencephalography (EEG) were combined with haemodynamic data obtained through functional magnetic resonance imaging (fMRI). Ten subjects affected by migraine (with or without aura) underwent TMS and EEG investigation prior to a visual stimulation task, studied in fMRI. Our preliminary results showed a reduced cortical silent period especially in subjects affected by migraine with aura. The fMRI BOLD response was found to be weaker in occipital areas proportionally to the frequency and severity of migraine attacks. The data obtained from our study seem to support the theory of cortical spreading depression recently observed in human subjects. Moreover, the electrophysiological data were also correlated to migraine attack frequency, thus pointing to elevated cortical excitability between attacks. Better understanding of the neuropathological processes that trigger migraine attacks will help in the selection of more adequate prophylactic therapies. The results of this preliminary study need to be confirmed in a a large sample of subjects.

A case of topiramate-induced epistaxis.

The current case describes epistaxis in a patient treated with a daily regimen of topiramate 100mg for migraine. The patient had not a past medical history of nosebleeds and laboratory parameters were within normal ranges. She was then advised to withdraw topiramate, and the epistaxis resolved within 12 hours after its discontinuation. Since then, the patient never complained other blood clotting disorders. The potential antiplatelet activity of topiramate is discussed.