https://doi.org/10.4081/cc.2024.15760
Anti-CGRP monoclonal antibodies improve cognitive function in patients affected by chronic migraine complicated with medication overuse-headache
Submitted: 20 March 2024
Accepted: 5 April 2024
Published: 7 May 2024
Accepted: 5 April 2024
Abstract Views: 1859
PDF: 375
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Background: Migraine represents one of the most disabling neurological diseases in the world. This burden is primarily due to recurrent pain episodes, alongside cognitive function impairments that patients may experience. This paper aims to explore the effect of three anti-calcitonin Gene-Related Peptide (CGRP) monoclonal antibodies (mAbs) – erenumab, fremanezumab, and galcanezumab – on the cognitive performance of a sample of patients suffering from migraine using the Montreal Cognitive Assessment (MoCA) questionnaire.
Methods: A total of 215 patients suffering from migraine who visited the Modena Headache Center were enrolled. The MoCA questionnaire was filled in by the patients at the baseline and subsequent assessments were conducted at 6 and 12 months thereafter. Additionally, patients were requested to complete the 6-item Headache Impact Test, Migraine Disability Assessment Score, and Hospital Anxiety and Depression Scale every three months.
Results: The sample was composed of 82% of female participants and 87% of the enrolled patients were diagnosed with chronic migraine. Following one year of treatment, there was a significant enhancement observed in MoCA scores compared to baseline measurements. Moreover, higher consumption of analgesics, elevated body mass index (BMI), and prolonged chronic migraine history exhibited an inverse correlation with MoCA score improvements after 12 months.
Conclusions: Erenumab, fremanezumab, and galcanezumab have proven to be effective in relieving the cognitive impairment associated with migraine after 1 year of treatment. These findings underscore the reversibility of cognitive impairment among migraine sufferers, even among those suffering from chronic migraine, as delineated by the majority of the patients under study. This study revealed that prolonged chronic migraine history, higher baseline analgesic intake, and elevated BMI were all predictive of diminished cognitive enhancements following treatment.
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd Edition. Cephalalgia 2018;38:1-211.
DOI: https://doi.org/10.1177/0333102417738202
Ashina M, Katsarava Z, Do TP, Buse DC, Pozo-Rosich P, Özge A, et al. Migraine: epidemiology and systems of care. Lancet 2021;397:1485-95.
DOI: https://doi.org/10.1016/S0140-6736(20)32160-7
Messina R, Cetta I, Colombo B, Filippi M. Tracking the evolution of non-headache symptoms through the migraine attack. J Headache Pain 2022;23:149.
DOI: https://doi.org/10.1186/s10194-022-01525-6
Dodick DW. A phase-by-phase review of migraine pathophysiology. Headache 2018;58:4-16.
DOI: https://doi.org/10.1111/head.13300
Vuralli D, Ayata C, Bolay H. Cognitive dysfunction and migraine. J Headache Pain 2018;19.
DOI: https://doi.org/10.1186/s10194-018-0933-4
Gil-Gouveia R, Oliveira AG, Martins IP. The impact of cognitive symptoms on migraine attack-related disability. Cephalalgia 2016;36:422-30.
DOI: https://doi.org/10.1177/0333102415604471
Gil-Gouveia R, Martins IP. Clinical description of attack-related cognitive symptoms in migraine: a systematic review. Cephalalgia 2018;38:1335-50.
DOI: https://doi.org/10.1177/0333102417728250
Edwards KR, Rosenthal BL, Farmer KU, Cady RK, Browning R. Evaluation of sumatriptan-naproxen in the treatment of acute migraine: a placebo-controlled, double-blind, cross-over study assessing cognitive function. Headache 2013;53:656-64.
DOI: https://doi.org/10.1111/head.12052
Latysheva N, Filatova E, Osipova D, Danilov AB. Cognitive impairment in chronic migraine: a cross-sectional study in a clinic-based sample. Arq Neuropsiquiatr 2020;78:133-8.
DOI: https://doi.org/10.1590/0004-282x20190159
Vandenbussche N, Laterza D, Lisicki M, Lloyd J, Lupi C, Tischler H, et al. Medication overuse-headache: a widely recognized entity amidst ongoing debate. J Headache Pain 2018;19:50.
DOI: https://doi.org/10.1186/s10194-018-0875-x
Cai X, Xu X, Zhang A, Lin J, Wang W, He W, Fang Y. Cognitive decline in chronic migraine with nonsteroid anti-inflammation drug overuse: a cross-sectional study. Pain Res Manag 2019;2019:7307198.
Cohen F, Yuan H, DePoy EMG, Silberstein SD. The arrival of anti-CGRP monoclonal antibodies in migraine. Neurotherapeutics 2022; 19:922-30.
DOI: https://doi.org/10.1007/s13311-022-01230-x
Cantarelli L, Grafiňa DP, Perez AG, Gil SG, Nicolàs FG, Santana ER, et al. Efficacy and safety of erenumab, galcanezumab, and fremanezumab in the treatment of drug-resistant chronic migraine: experience in real clinical practice. Ann Pharmacother 2022;10600280221118402.
DOI: https://doi.org/10.1177/10600280221118402
Dautzenberg G, Lijmer J, Beekman A. Clinical value of the Montreal Cognitive Assessment (MoCA) in patients suspected of cognitive impairment in old age psychiatry. Using the MoCA for triaging to a memory clinic. Cogn Neuropsychiatry 2021;26:1-17.
DOI: https://doi.org/10.1080/13546805.2020.1850434
Santangelo G, Russo A, Tessitore A, Garramone F, Silvestro M, Della Mura MR, et al. Prospective memory is dysfunctional in migraine without aura. Cephalalgia 2018;38:1825-32.
DOI: https://doi.org/10.1177/0333102418758280
González-Mingot C, Gil-Sánchez A, Canudes-Solans M, Peralta-Moncusi S, Solana-Moga MJ, Brieva-Ruiz L. Preventive treatment can reverse cognitive impairment in chronic migraine. J Headache Pain 2022;23:121.
DOI: https://doi.org/10.1186/s10194-022-01486-w
Ramos-Henderson M, Calderon C, Toro-Rao I, Aguilera-Choppelo R, Palominos D, Soto-Anari M, et al. The cumulative effect of fibromyalgia symptoms on cognitive performance: the mediating role of pain. Appl Neuropsychol Adult 2022;14:1-11.
DOI: https://doi.org/10.1080/23279095.2022.2122828
Zhang X, Zhou J, Guo M, Cheng S, Chen Y, Jiang N, et al. A systematic review and meta-analysis of voxel-based morphometric studies of migraine. J Neurol 2022; 270, pages 152–170
DOI: https://doi.org/10.1007/s00415-022-11363-w
Olesen J, Burstein R, Ashina M, Tfelt-Hansen P. Origin of pain in migraine: evidence for peripheral sensitization. Lancet Neurol 2009;8:679-90.
DOI: https://doi.org/10.1016/S1474-4422(09)70090-0
Russo A, Silvestro M, Troisi F, Bisecco A, Di Micco R, Caiazzo G, et al. Cognitive networks disarrangement in patients with migraine predicts cutaneous allodynia. Headache 2020;60:1228-43.
DOI: https://doi.org/10.1111/head.13860
Iannone LF, De Cesaris F, Ferrari A, Benemei S, Chiarugi A. Effectiveness of anti-CGRP monoclonal antibodies on central symptoms of migraine. Cephalalgia 2022;3331024221111526.
DOI: https://doi.org/10.1177/03331024221111526
Iyengar S, Ossipov MH, Johnson KW. The role of calcitonin gene-related peptide in peripheral and central pain mechanisms including migraine. Pain 2017;158:543-99.
DOI: https://doi.org/10.1097/j.pain.0000000000000831
Michels L, Koirala N, Groppa S, Luechinger R, Gantenbein AR, Sandor PS, et al. Structural brain network characteristics in patients with episodic and chronic migraine. J Headache Pain 2021;22:8.
DOI: https://doi.org/10.1186/s10194-021-01216-8
Russo A, Tessitore A, Silvestro M, Di Nardo F, Trojsi F, Del Santo T, et al. Advanced visual network and cerebellar hyperresponsiveness to trigeminal nociception in migraine with aura. J Headache Pain 2019;20:46.
DOI: https://doi.org/10.1186/s10194-019-1002-3
Coppola G, Di Renzo A, Petolicchio B, Tinelli E, Di Lorenzo C, Serrao M, et al. Increased neural connectivity between the hypothalamus and cortical resting-state functional networks in chronic migraine. J Neurol 2020;267:185-91.
DOI: https://doi.org/10.1007/s00415-019-09571-y
Messina R, Meani A, Riccitelli GC, Colombo B, Filippi M, Rocca MA. Neural correlates of visuospatial processing in migraine: does the pain network help? Mol Psychiatry 2021;26:6599-608.
DOI: https://doi.org/10.1038/s41380-021-01085-2
Chen C, Dong X, Gu P, Chen K, Wan Q, Xie H, et al. Attention impairment during the inter-ictal state in migraineurs without aura: a cross-sectional study. J Pain Res 2021;14:3073-83.
DOI: https://doi.org/10.2147/JPR.S312181
Guo Y, Chen J, Hou X, Xu S, Ma Y, Nie S, et al. Pre-attentive dysfunction of processing emotional faces in interictal migraine revealed by expression-related visual mismatch negativity. Brain Res 2020;1738:146816.
DOI: https://doi.org/10.1016/j.brainres.2020.146816
Karlsson IK, Gatz M, Arpawong TE, Aslan AKD, Reynolds CA. The dynamic association between body mass index and cognition from midlife through late-life, and the effect of sex and genetic influences. Sci Rep 2021;11:7206.
DOI: https://doi.org/10.1038/s41598-021-86667-4
Vernieri F, Brunelli N, Marcosano M, Aurilia C, Egeo G, Lovati C, et al. Maintainance of response and predictive factors of one-year GalcanezumAb treatment in Real Life migraine patients in ITaly; the multicenter prospective cohort GARLIT study. Eur J Neurol 2023;30:224-34.
DOI: https://doi.org/10.1111/ene.15563
Kawai T, Autieri MV, Scalia R. Adipose tissue inflammation and metabolic dysfunction in obesity. Am J Physiol Cell Physiol 2021;320;C375-391.
DOI: https://doi.org/10.1152/ajpcell.00379.2020
Edvinsson L, Agmund Haanes K, Warfringe K. Does inflammation have a role in migraine? Nat Rev Neurol 2019;15:483-90.
DOI: https://doi.org/10.1038/s41582-019-0216-y
Lim A, Krajina K, Marsland AL. Peripheral inflammation and cognitive aging. Mod Trends Pharmacopsychiatry 2013;28:175-87.
DOI: https://doi.org/10.1159/000346362
Thuraiaiyah J, Erritzøe-Jervild M, Al-Khazali HM, Schytz HW, Younis S. The role of cytokines in migraine: a systematic review. Cephalalgia 2022;42:1565-88.
DOI: https://doi.org/10.1177/03331024221118924
Recober A, Goadsby PJ. Calcitonin gene-related peptide (CGRP): a molecular link between obesity and migraine? Drugs News Perspect 2010;23:112-7.
DOI: https://doi.org/10.1358/dnp.2010.23.2.1475909
Xiang Y, Chen S, Lin H, Xiong W, Zheng Z. Cognitive function and white matter lesions in medication-overuse headache. J Pain Res 2021;14:1845-53.
DOI: https://doi.org/10.2147/JPR.S310064
Cai X, Xu X, Zhang A, Lin J, Wang X, He W, Fang Y. Cognitive decline in chronic migraine with nonsteroid anti inflammation drug overuse: a cross-sectional study. Pain Res Manag 2019;2019:7307198.
DOI: https://doi.org/10.1155/2019/7307198
Huang L, Juan Dong H, Wang W, Wang Y, Xiao Z. Duration and frequency of migraines affect cognitive function: evidence from neuropsychological tests and event-related potentials. J Headache Pain 2017;18:54.
DOI: https://doi.org/10.1186/s10194-017-0758-6
Coppola G, Di Renzo A, Tinelli E, Leptre C, Di Lorenzo C, Di Lorenzo G, et al. Thalamo-cortical network activity between migraine attacks: insights from MRI-based microstructural and functional resting-state network collaboration analysis. J Headache Pain 2016;17:100.
DOI: https://doi.org/10.1186/s10194-016-0693-y
Baraldi C, Castro FL, Cainazzo MM, Pani L, Guerzoni S. Predictors of response to erenumab after 12 months of treatment. Brain Behav 2021;11:e2260.
DOI: https://doi.org/10.1002/brb3.2260
Qin Z, Su J, He XW, Ban S, Zhu Q, Cui Y, et al. Disrupted functional connectivity between sub-regions in the sensorimotor areas and cortex in migraine without aura. J Headache Pain 2020;21:47.
DOI: https://doi.org/10.1186/s10194-020-01118-1
Martins IP, Maruta C, Alves PN, Loureiro C, Morgado J, Tavares J, Gil-Gouveia R. Cognitive aging in migraine sufferers are associated with more subjective complaints but similar age-related decline: a 5-year longitudinal study. Pain 2020;21:31.
DOI: https://doi.org/10.1186/s10194-020-01100-x
Irimia P, Garrido-Cumbrera M, Santos-Lasaosa S, Aguirre-Vazquez M, Correa-Fernandez J, Colomina I, Pozo-Rosich P. Impact of monthly headache days on anxiety, depression, and disability in migraine patients: results from the Spanish Atlas. Sci Rep 2021;11:8286.
DOI: https://doi.org/10.1038/s41598-021-87352-2
Dotson VM, Szymkowicz SM, Kirton JW, McLaren ME, Green ML, Rohani JY. Unique and interactive effect of anxiety and depressive symptoms on cognitive and brain function in young and older adults. J Depress Anxiety 2014;1:22565.
DOI: https://doi.org/10.4172/2167-1044.S1-003
Cainazzo MM, Baraldi C, Ferrari A, Lo Castro F, Pani L, Guerzoni S. Erenumab for the preventive treatment of chronic migraine complicated with medication overuse headache: an observational, retrospective, 12-month real-life study. Neurol Sci 2021;42:4193-202.
DOI: https://doi.org/10.1007/s10072-021-05105-5
Ornello R, Riseo C, Frattale I, Perrotta G, Marini C, Pistoia F, Sacco S. The appropriate dosing of erenumab for migraine prevention after multiple preventive treatment failures: a critical appraisal. J Headache Pain 2019;20:99.
DOI: https://doi.org/10.1186/s10194-019-1054-4
Schoenen J, Van Dycke A, Versijpt J, Paemeleire K. Ten open questions in migraine prophylaxis with monoclonal antibodies blocking the calcitonin-gene related peptide pathway: a narrative review. J Headache Pain 2023;24:99.
DOI: https://doi.org/10.1186/s10194-023-01637-7
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361-70.
DOI: https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
Yang M, Rendas-Baum R, Varon SF, Kosinski M. Validation of the Headache Impact Test (HIT-6TM) across episodic and chronic migraine. Cephalalgia 2011;31:357-67.
DOI: https://doi.org/10.1177/0333102410379890
Stewart WF, Lipton RB, Kolodner KB, Sawyer J, Lee C, Liberman JN. Validity of the Migraine Disability Assessment (MIDAS) score in comparison to a diary-based measure in a population sample of migraine sufferers. Pain 2000;88:41-52.
DOI: https://doi.org/10.1016/S0304-3959(00)00305-5
Ho S, Darby D, Bear N. Cognitive effects of onabotulinumtoxinA in chronic migraine. BMJ Neurol Open 2020;2:e000014.
DOI: https://doi.org/10.1136/bmjno-2019-000014
How to Cite
1.
Guerzoni S, Lo Castro F, Baraldi C, Brovia D, Tascedda F, Rivi V, et al. Anti-CGRP monoclonal antibodies improve cognitive function in patients affected by chronic migraine complicated with medication overuse-headache. Confinia Cephalal [Internet]. 2024 May 7 [cited 2024 Nov. 23];34(1). Available from: https://www.confiniacephalalgica.com/site/article/view/15760
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