• Umberto Pensato, Carlo Baraldi, Valentina Favoni, Maria Michela Cainazzo, Paola Torelli, Pietro Querzani, Alessia Pascazio, Davide Mascarella, Eleonora Matteo, Simone Quintana, Gian Maria Asioli, Pietro Cortelli, Giulia Pierangeli, Simona Guerzoni, and Sabina Cevoli.
• Department of Biomedical and NeuroMotor Sciences of Bologna, University of Bologna, Bologna, Italy.
• Neurol. Sci. 2021 Jul 5.

ObjectiveTo determine whether erenumab is effective and safe in refractory chronic migraine with medication overuse headache.MethodsIn this prospective, multicentric, real-life study, chronic migraine with medication overuse headache patients who received erenumab were recruited. Study inclusion was limited to patients who previously failed onabotulinumtoxinA in addition to at least three other pharmacological commonly used migraine preventive medication classes.ResultsOf 396 patients who received erenumab, 38% (n = 149) met inclusion criteria. After 3 months, 51% (n = 76) and 20% (n = 30) patients achieved ≥ 50% and ≥ 75% reduction in monthly headache days, respectively. Monthly pain medications intake decreased from 46.1 ± 35.3 to 16.8 ± 13.9 (p < 0.001), while monthly headache days decreased from 25.4 ± 5.4 to 14.1 ± 8.6 (p < 0.001). Increasing efficacy of erenumab over the study period was observed. Allodynia was a negative predictive factor of erenumab response (odds ratio = 0.47; p = 0.03). Clinical conversion to episodic migraine with no medication overuse was observed in 64% (n = 96) patients. No serious adverse events were observed.ConclusionsErenumab reduced significantly migraine frequency and pain medication intake in refractory chronic migraine with MOH patients.

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