Despite the widespread experience of headaches for patients with an idiopathic intracranial hypertension (IIH) new research demonstrated that treatment with the calcitonin gene-related protein (CGRP) monoclonal antibody didn’t result in significant reductions of more than 50% in the number of monthly day-time headaches (MHD) when compared to the placebo. 1

The lead researcher Lindsay Frerichs, MD, fellow, UT Southwestern Medical Center and co-authors conducted an examination of the chart of patients who had an established diagnosis of IIH and who received treatment from May 2018 through January 2020 using anti-CGRP monoclonal antibodies. After the study, there was there was no statistically significant difference regarding the change in MHD which is the main final outcome at 3 months (95 percent interval, -0.05 to 0.44) or 6 months (95 percent 95% CI, -0.95 to 0.59).

The research, which was that was presented during the 2022 American Headache Society (AHS) Annual Meeting, which took place from June 9-12 located in Denver, Colorado, aimed to determine the function of migraine as well as its pathophysiology chronic post-IIH headache. IIH is a rare disorder often referred to as pseudotumor cerebri can occur when there’s a lot of cerebrospinal fluid accumulation, placing extra stress on both the optic nerve. The signs of the condition are headaches and tinnitus, as well as temporarily blindness and double vision blind spots, shoulder and neck discomfort, and the loss of peripheral vision.


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Overall, only 24 out of 79 examined chart were included within the study. This included majority of the cohort being females (95.8 percent of the patients; n = 23) as well as Caucasian (75 percent of the sample; n > 18). In the initial phase, patients showed the mean MHD in the range of 24.39 (SD, 7.35) and Migraine Disability Assessment scores of 88.39 (SD, 63.58) which indicates the severity. Patients tried at least 5.87 (SD, 2.82) migraine preventive medications, and 62.5 percent experiencing overuse headache.

Galcanezumab (Emgality; Eli Lily) as well as Erenumab (Aimovig; Novartis), and Fremanezumab (Ajovy; Teva Pharmaceuticals), the sole approved GCRP monoclonal antibody at the time of analysis were utilized by 10 (41.7 percent) 9 (37.5 percent) and 4 (16.7 percent) patients according to. Additionally, there were not having statistically significant differences in this primary endpoint, the second measurement of the amount of MHD at 25 percent 75%, 25%, at the bare minimum, or 100 percent from baseline not also met.

There aren’t many studies that specifically examined drugs which focus on CGRP pathways to treat headaches in IIH. One study from 2020 involved 7 patients for which headaches were the most prominent symptom of IIH and the headaches with migraine-like features like those that are typical of most patients with the disease. The headaches have responded strongly to the drug erenumab. However, there was a return of an increased intracranial pressure that was raised, which was evident in the returning papilledema that was previously cured prior to treatment. However that the headaches didn’t recur taking erenumab for treatment, which suggests that CGRP might be a possible motor that causes headaches in patients suffering from chronic IIH. 2


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REFERENCES

1. Frerichs L, Nandy K, Friedman DI. The efficacy of monoclonal anti-CGRP antibodies to treat persistent headaches in patients suffering from an idiopathic intracranial hypertension. Presentation during: AHS Annual Meeting, 2022, June 9-12, Denver, CO. P-119.

2. Yiangou A, Mitchell JL, Vijay V, et al. Calcitonin monoclonal gene-related peptide antibody is used to treat headaches for patients with chronic idiopathic intracranial hypertension. J Headache Pain. 2020;21(1):116. doi:10.1186/s10194-020-01182-7.

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