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The Journal of Headache and Pain
Published in: The Journal of Headache and Pain 1/2018

Open Access 01-12-2018 | Research article

Migraine induction with calcitonin gene-related peptide in patients from erenumab trials

Authors: Casper Emil Christensen, Samaira Younis, Marie Deen, Sabrina Khan, Hashmat Ghanizada, Messoud Ashina

Published in: The Journal of Headache and Pain | Issue 1/2018

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Abstract

Background

Migraine prevention with erenumab and migraine induction by calcitonin gene-related peptide (CGRP) both carry notable individual variance. We wanted to explore a possible association between individual efficacy of anti-CGRP treatment and susceptibility to migraine induction by CGRP.

Methods

Thirteen migraine patients, previously enrolled in erenumab anti-CGRP receptor monoclonal antibody trials, received CGRP in a double-blind, placebo-controlled, randomized cross-over design to investigate their susceptibility to migraine induction. A standardized questionnaire was used to assess the efficacy of previous antibody treatment. The patients were stratified into groups of high responders and poor responders. Primary outcomes were incidence of migraine-like attacks and area under the curve of headache intensity after infusion of CGRP and placebo. All interviews and experiments were performed in laboratories at the Danish Headache Center, Copenhagen, Denmark.

Results

Ten high responders and three poor responders were included. CGRP induced migraine-like attacks in ten (77%) patients, whereof two were poor responders, compared to none after placebo (p = 0.002). The area under the curve for headache intensity was greater after CGRP, compared to placebo, at 0–90 min (p = 0.009), and 2–12 h (p = 0.014). The median peak headache intensity score was 5 (5–9) after CGRP, compared to 2 (0–4) after placebo (p = 0.004).

Conclusions

Patients with an excellent effect of erenumab are highly susceptible to CGRP provocation. If an association is evident, CGRP provocation could prove a biomarker for predicting antibody treatment efficacy.

Trial registration

Retrospectively registered at clinicaltrials.gov with identifier: NCT03481400.
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Metadata
Title
Migraine induction with calcitonin gene-related peptide in patients from erenumab trials
Authors
Casper Emil Christensen
Samaira Younis
Marie Deen
Sabrina Khan
Hashmat Ghanizada
Messoud Ashina
Publication date
01-12-2018
Publisher
Springer Milan
Published in
The Journal of Headache and Pain / Issue 1/2018
Print ISSN: 1129-2369
Electronic ISSN: 1129-2377
DOI
https://doi.org/10.1186/s10194-018-0927-2

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