Jasem Al-Hashel, Consultant Neurologist and Associate Professor of Neurology, Faculty of Medicine, Kuwait University, Kuwait
Migraine is prevalent in Kuwait and is associated with a significant socioeconomic burden.1,2 In a community-based study of 15,523 patients aged 18-65 years, 23% were diagnosed with episodic headache, 5.4% with chronic migraine and 2.4% with medication overuse headache.1 The female:male ratio was 1.7:1. In the three months before the survey, respondents with episodic migraine had lost a mean of 1.97 days from their paid work or school attendance compared to 6.62 days in those with chronic headache (p < 0.001).2
Following the approval of the CGRP monoclonal antibodies (MAbs), erenumab in December 2018 and galcanezumab in early 2019, for the preventive treatment of episodic and chronic migraine, we started to assess their efficacy and safety in our tertiary centre in Kuwait.
In our prospective study of 63 patients with migraine, the mean age was 45 years and the mean disease duration was 22 years. More than three quarters of patients were women. Chronic migraine and medication overuse headache (MOH) were reported in our cohort in 8% and 49% respectively. Over half of patients had used two or more previous prophylactic medications.
Mean duration of CGRP MAb use was eight months, and most of our study participants (64%) moved to CGRP MAbs because of lack of efficacy of their previous prophylactic medication and only 20% moved because of adverse events. Our patients received erenumab or galcanezumab every four weeks and were followed up for at least three months.
Over two-thirds of our patients (68%) had at least a 50% reduction in mean number of migraine days per month. At their last visit, patients had a significant reduction in migraine days from 14.04 to 5.13 days (p<0.01). They also had significantly fewer days when they needed analgesics (6.43 days vs 15.85 days, p<0.0001). Headache severity was reduced from 9.67 to 5.40 (p<0.001) on the visual analogue scale (VAS).
At their last visit, 81% of patients showed improved quality of life and 90% of those with chronic migraine or MOH at the start of our study had converted to episodic migraine (p<0.0001). The majority of patients (71.4%) were satisfied with treatment with CGRP MAbs.
In our study, 14% of patients reported adverse events, most commonly injection-site pain (6.4%), and constipation (6.4%). No serious adverse events or adverse events leading to treatment discontinuation were reported. Only two patients withdrew (3.2%) because of lack of efficacy.
In our experience, prophylactic CGRP MAb treatment for migraine was efficacious and reduced the number of monthly migraine days and the use of analgesics. It improved quality of life, and it was well tolerated and safe.