Monoclonal Antibodies for Chronic Migraine and Medication Overuse Headache: A Real-world Study

Overview

Journal Front Neurol

Specialty Neurology

Date 2023 Mar 20

PMID 36937507

Authors

Abouch V Krymchantowski

Carla Jevoux

Ana Gabriela Krymchantowski

Raimundo Pereira Silva-Neto

Affiliations

Soon will be listed here.

Abstract

Background: Medication-overuse headache is highly prevalent in tertiary care centers. It may be a cause or consequence of the overuse of symptomatic medications for migraine attacks.

Objective: We aimed to compare the efficacy of anti-CGRP monoclonal antibodies (mAbs) added to conventional pharmacological treatments in patients with chronic migraine (CM) and medication overuse headache (MOH).

Methods: A cross-sectional, prospective, randomized, open study with real-world comparison groups of patients was carried out. The sample consisted of 200 patients with CM and MOH, who received the same approach to withdraw overused medications, started preventative treatment, and either did or did not receive mAbs.

Results: A total of 172 patients (126 women and 46 men) were included in the study and divided into two groups: group one consisting of 58 patients (control) and group two of 114 patients who used mAbs added to conventional pharmacological agents. The mean age was 44.1 ± 13.6 years, ranging from 18 to 78 years. In the 3 months follow-up after starting the treatment, both groups presented headache frequency reduction, but those with monoclonal antibodies had a significantly higher reduction in the number of headache days and symptomatic medication intake when compared to the control ( < 0.0001).

Conclusions: The addition of an anti-CGRP monoclonal antibody to the treatment for medication overuse headaches in chronic migraineurs may result in decreasing headache frequency and symptomatic medication use when compared to conventional treatments with drugs.

Citing Articles

Critical reflections on medication overuse headache in patients with migraine: An unsolved riddle in nociception.

Chiarugi A, Buonvicino D Neurobiol Pain. 2025; 17:100179.

PMID: 40040782 PMC: 11876746. DOI: 10.1016/j.ynpai.2025.100179.

Network meta-analysis comparing efficacy of different strategies on medication-overuse headache.

Koonalintip P, Yamutai S, Setthawatcharawanich S, Thongseiratch T, Chichareon P, Wakerley B J Headache Pain. 2025; 26(1):43.

PMID: 40011869 PMC: 11863719. DOI: 10.1186/s10194-025-01982-9.

Real-world clinical results of CGRP monoclonal antibody treatment for medication overuse headache of migraine without abrupt drug discontinuation and no hospitalization.

Tanei T, Fuse Y, Maesawa S, Nishimura Y, Ishizaki T, Nagashima Y Heliyon. 2025; 10(22):e40190.

PMID: 39748981 PMC: 11693917. DOI: 10.1016/j.heliyon.2024.e40190.

Medication-Overuse Headache: Update on Management.

Koonalintip P, Phillips K, Wakerley B Life (Basel). 2024; 14(9).

PMID: 39337929 PMC: 11432938. DOI: 10.3390/life14091146.

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

Pons-Fuster E, Lozano-Caballero O, Martin-Balbuena S, Lucas-Rodenas C, Mancebo-Gonzalez A, De Gorostiza-Frias I Int J Clin Pharm. 2024; 46(6):1317-1326.

PMID: 38990457 DOI: 10.1007/s11096-024-01758-2.

References

Hagen K, Stovner L . A randomized controlled trial on medication-overuse headache: outcome after 1 and 4 years. Acta Neurol Scand Suppl. 2011; (191):38-43. DOI: 10.1111/j.1600-0404.2011.01542.x. View

Sun-Edelstein C, Rapoport A, Rattanawong W, Srikiatkhachorn A . The Evolution of Medication Overuse Headache: History, Pathophysiology and Clinical Update. CNS Drugs. 2021; 35(5):545-565. DOI: 10.1007/s40263-021-00818-9. View

Krymchantowski A, Jevoux C, Krymchantowski A, Vivas R, Silva-Neto R . Medication overuse headache: an overview of clinical aspects, mechanisms, and treatments. Expert Rev Neurother. 2020; 20(6):591-600. DOI: 10.1080/14737175.2020.1770084. View

Marmura M, Diener H, Cowan R, Tepper S, Diamond M, Starling A . Preventive migraine treatment with eptinezumab reduced acute headache medication and headache frequency to below diagnostic thresholds in patients with chronic migraine and medication-overuse headache. Headache. 2021; 61(9):1421-1431. PMC: 9291601. DOI: 10.1111/head.14206. View

Munksgaard S, Madsen S, Wienecke T . Treatment of medication overuse headache-A review. Acta Neurol Scand. 2019; 139(5):405-414. DOI: 10.1111/ane.13074. View

Saper J, Da Silva A . Medication overuse headache: history, features, prevention and management strategies. CNS Drugs. 2013; 27(11):867-77. DOI: 10.1007/s40263-013-0081-y. View

Krymchantowski A, Tepper S, Jevoux C, Valenca M . Medication-Overuse Headache: Protocols and Outcomes in 149 Consecutive Patients in a Tertiary Brazilian Headache Center. Headache. 2016; 57(1):87-96. DOI: 10.1111/head.12970. View

Westergaard M, Glumer C, Hansen E, Jensen R . Prevalence of chronic headache with and without medication overuse: associations with socioeconomic position and physical and mental health status. Pain. 2014; 155(10):2005-13. DOI: 10.1016/j.pain.2014.07.002. View

Pensato U, Baraldi C, Favoni V, Mascarella D, Matteo E, Andrini G . Detoxification vs non-detoxification before starting an anti-CGRP monoclonal antibody in medication overuse headache. Cephalalgia. 2022; 42(7):645-653. PMC: 9109244. DOI: 10.1177/03331024211067791. View

10.

Diener H, Marmura M, Tepper S, Cowan R, Starling A, Diamond M . Efficacy, tolerability, and safety of eptinezumab in patients with a dual diagnosis of chronic migraine and medication-overuse headache: Subgroup analysis of PROMISE-2. Headache. 2020; 61(1):125-136. DOI: 10.1111/head.14036. View

11.

Silberstein S, Dodick D, Bigal M, Yeung P, Goadsby P, Blankenbiller T . Fremanezumab for the Preventive Treatment of Chronic Migraine. N Engl J Med. 2017; 377(22):2113-2122. DOI: 10.1056/NEJMoa1709038. View

12.

Tepper S, Diener H, Ashina M, Brandes J, Friedman D, Reuter U . Erenumab in chronic migraine with medication overuse: Subgroup analysis of a randomized trial. Neurology. 2019; 92(20):e2309-e2320. PMC: 6598821. DOI: 10.1212/WNL.0000000000007497. View

13.

Carlsen L, Munksgaard S, Nielsen M, Engelstoft I, Westergaard M, Bendtsen L . Comparison of 3 Treatment Strategies for Medication Overuse Headache: A Randomized Clinical Trial. JAMA Neurol. 2020; 77(9):1069-1078. PMC: 7251504. DOI: 10.1001/jamaneurol.2020.1179. View

14.

Dodick D, Doty E, Aurora S, Ruff D, Stauffer V, Jedynak J . Medication overuse in a subgroup analysis of phase 3 placebo-controlled studies of galcanezumab in the prevention of episodic and chronic migraine. Cephalalgia. 2020; 41(3):340-352. DOI: 10.1177/0333102420966658. View

15.

Krymchantowski A, Moreira P . Out-patient detoxification in chronic migraine: comparison of strategies. Cephalalgia. 2004; 23(10):982-93. DOI: 10.1046/j.1468-2982.2003.00648.x. View

16.

Ambrosini A, Estemalik E, Pascual J, Rettiganti M, Stroud C, Day K . Changes in acute headache medication use and health care resource utilization: Results from a randomized, double-blind, placebo-controlled clinical trial evaluating galcanezumab in adults with treatment-resistant migraine (CONQUER). J Manag Care Spec Pharm. 2022; 28(6):645-656. DOI: 10.18553/jmcp.2022.21375. View

17.

Grazzi L, Sansone E, Raggi A, DAmico D, De Giorgio A, Leonardi M . Mindfulness and pharmacological prophylaxis after withdrawal from medication overuse in patients with Chronic Migraine: an effectiveness trial with a one-year follow-up. J Headache Pain. 2017; 18(1):15. PMC: 5292107. DOI: 10.1186/s10194-017-0728-z. View

18.

Krymchantowski A, Adriano M, de Goes R, Moreira P, Jevoux C . Adherence to headache treatment and profile of previous health professional seeking among patients with chronic headache: a retrospective analysis. MedGenMed. 2007; 9(2):21. PMC: 1994857. View

19.

Krymchantowski A, Jevoux C . The pharmacological treatment of migraine in Brazil. Headache. 2015; 55 Suppl 1:51-8. DOI: 10.1111/head.12513. View

20.

. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018; 38(1):1-211. DOI: 10.1177/0333102417738202. View