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.

[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.

[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.

Síndrome HaNDL y encefalopatía de Hashimoto. Réplica / HaNDL syndrome and Hashimoto's encephalopathy. Reply

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Migraña como factor predictorde la presencia de aneurisma del septoauricular en pacientes con ictusy foramen oval permeable / Migraine as predictive factor of the presence of atrial septum aneurysm in patients with stroke and patent foramen ovale

Introducción. El infarto cerebral (IC) en pacientes jóvenes seasocia, hasta en un 30% de los casos a foramen oval permeable (FOP)con o sin aneurisma del septo auricular (ASA). Se ha observado unafrecuente relación entre FOP y migraña, pero no se ha analizado laposible asociación entre ASA y migraña en pacientes con IC.Métodos. Estudio observacional a partir de la base de datos dela unidad de ictus del servicio de neurología de un hospital universitariodurante el período de enero de 1994 a diciembre de 2005. Seseleccionaron aquellos pacientes a los que se les había realizado unecocardiograma transesofágico (ETE). Se realizaron dos grupos segúnel antecedente de migraña y la existencia de FOP, evaluando el riesgode asociación entre FOP y ASA en los pacientes con migraña medianteanálisis de regresión logística.Resultados. A 631 se realizó ETE; tenían FOP 61 pacientes (9,7%),ASA aislado 34 (5,4%) y la combinación de ambos 22 (3,49%). La presenciade FOP y migraña asociaba mayor frecuencia de ASA que aquellosFOP sin migraña (75 frente al 30,2%), con un riesgo de asociarambas alteraciones de 2,5 (intervalo de confianza del 95%: 1,4-4,4).En el subgrupo de pacientes menores de 55 años el antecedente demigraña se asoció a un riesgo nueve veces superior de presentar estacombinación, independientemente de la edad y el sexo.Conclusiones. En los pacientes con IC y FOP la probabilidad deasociar ASA sería mayor en pacientes con migraña. Este hallazgo tieneimplicaciones diagnósticas, sugiriendo la búsqueda de esta asociaciónen estos pacientes (AU)

Introduction. Ischemic stroke in young patients is associatedin up to 30% of cases to a patent foramen ovale (PFO) with orwithout atrial septum aneurism (ASA). Besides, a frequent associationbetween migraine and PFO has been described, but fewstudies have addressed the possible association between ASA andmigraine in stroke patients.Methods. Observational study with inclusion of consecutiveischemic stroke patients in a Stroke Unit Data Bank of the Departmentof Neurology of a university hospital admitted betweenJanuary 1994 and December 2005. Those patients who underwenttransesophageal echocardiography (TEE) were selected andclassified in two groups regarding the history of previous migraine.Logistic regression analysis models were developed to assessthe risk of the combination of PFO and ASA in patients with migraine.Results. 631 stroke patients with TEE were included. PFO waspresent in 61 patients (9.7%), isolated ASA in 34 (5.4%) and bothabnormalities in 22 (3.49%). Patients with migraine and PFO hadhigher frequency of ASA than those with PFO and no migraine(75 vs 30.2%), and the relative risk to carry double interatrial septalabnormalities was 2.5 (95% confidence interval: 1.4-4.4). Inthe subgroup of patients under 55 years old, migraine history wasassociated to a nine-folder relative risk of carrying this combination,independently of age or gender.Conclusions. In patients with ischemic stroke and PFO theprobability of having ASA could be higher in migrainous. Thisfinding could have diagnostic implications, suggesting the convenienceto seek for this association in these patients (AU)

Réplica. Pseudomigraña con pleocitosis y la ‘invisibilidad’ de las descripciones originales en castellano / Pseudomigraine with pleocytosis and the 'invisibility’ of the original reports in Spanish. Reply

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

El síndrome de pseudomigraña con pleocitosis (PMP) de líquido cefalorraquídeo o síndrome de cefaleay déficit neurológicos transitorios con pleocitosis en el líquido cefalorraquídeo (HaNDL) es una entidad de la que se han llevado a cabo múltiples aportaciones sobre su etiofisiopatología en los 25 años desde su descubrimiento. Desarrollo. La PMP se describe en 1980 por Swanson, Bartleson y Whisnant, y paralelamente por Martí-Massó, y desde entonces se hanaportado numerosos casos, algunos atípicos por cefalea leve, recurrencia prolongada, hipertensión intracraneal sintomática o infecciones por citomegalovirus que simulan PMP. También se han propuesto varios criterios diagnósticos a lo largo de los años, establecidos actualmente en el año 2004 (International Classification of Headache Disorders). Se han realizado aportacionesa su conocimiento gracias a la realización de electroencefalogramas, tomografía con emisión de fotón único cerebral, Doppler transcraneal, potenciales evocados somatosensoriales, resonancia magnética cerebral de difusión-perfusión, lo queha dado lugar a la existencia de diversas teorías, como la infecciosa-autoinmune, disfunción de la barrera hematoencefálica, depresión cortical propagada, activación trigeminovascular, etc. Conclusiones. La PMP o HaNDL es una entidad benignacon etiofisiopatología aún desconocida y en la que es importante el diagnóstico diferencial con otras entidades potencialmente más peligrosas

The pseudomigraine syndrome with cerebrospinal fluid (CSF) and pleocytosis (PMP) or headachewith 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 Martí-Massó, 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 been 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 been 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… givingplace 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 unknownetiophysiopathology and where it is important the differential diagnosis with other entities potentially more dangerous