Erenumab significantly cuts migraine days and acute medication use in treatment-resistant chronic migraine with MOH.

Patients suffering from chronic migraine (CM), especially those with medication overuse headache (MOH), face a significant therapeutic challenge. This debilitating neurological disorder often proves resistant to conventional treatments, including multiple oral preventive medications and even botulinum toxin injections. The calcitonin gene-related peptide (CGRP) pathway plays a crucial role in migraine pathophysiology, making CGRP receptor antagonists like erenumab a targeted approach. However, real-world data on their efficacy in this highly refractory patient population, where previous treatments have failed, remains critical to guide clinical practice.

This single-center, retrospective observational study evaluated 73 patients at a University Medical Center diagnosed with both medication-overuse headache and treatment-resistant chronic migraine. All patients had previously failed at least three oral preventive medications and/or botulinum toxin injections. Participants received Erenumab 70 mg monthly via subcutaneous injection. Clinical data were extracted from medical records and patient interviews over a 3-month follow-up period. Key outcomes assessed included monthly migraine days, headache severity (measured by visual analog scale [VAS]), headache impact test (HIT-6) scores, acute medication use, and patient global impression of change (PGIC).

Erenumab treatment led to significant improvements across multiple migraine parameters. Monthly migraine days saw a mean reduction of 12.3 days (p<0.001), indicating a substantial decrease in headache frequency. The impact of headaches on daily life, as measured by HIT-6 scores, improved by a mean of 21 points (P <0.001). Headache severity, assessed via VAS, decreased by 6.1 points (P <0.001). Crucially, acute medication use was also significantly reduced by a mean of 14.8 days per month (P <0.001), suggesting a decreased reliance on abortive therapies. Most patients reported a "very good" or "good" improvement in their overall condition, with minimal side effects observed. This demonstrates robust efficacy in a challenging patient group.

Monthly migraine days were reduced by a mean of 12.3 days (p<0.001), and acute medication use decreased by 14.8 days (P <0.001).