Calcitonin gene related peptide monoclonal antibody treats headache in patients with active idiopathic intracranial hypertension
Yiangou, Andreas Mitchell, James L Vijay, Vivek Grech, Olivia Bilton, Edward Lavery, Gareth G Fisher, Claire Edwards, Julie Mollan, Susan P Sinclair, Alexandra J
Yiangou, Andreas
Mitchell, James L
Vijay, Vivek
Grech, Olivia
Bilton, Edward
Lavery, Gareth G
Fisher, Claire
Edwards, Julie
Mollan, Susan P
Sinclair, Alexandra J
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Affiliation
University of Birmingham; Birmingham Health Partners; University Hospitals Birmingham NHS Foundation Trust
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Publication date
2020-09-25
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Abstract
Background: Headache is the dominant factor for quality of life related disability in idiopathic intracranial hypertension (IIH) and typically has migraine-like characteristics. There are currently no evidence-based therapeutics for headache in IIH, and consequently this is an important unmet clinical need.
Case series: We report a series of seven patients in whom headaches were the presenting feature of IIH and the headaches had migraine-like characteristics, as is typical in many IIH patients. Papilloedema settled (ocular remission) but headaches continued. These headaches responded markedly to erenumab, a monoclonal antibody targeted against the calcitonin gene related peptide (CGRP) receptor. Of note, there was a recurrence of raised ICP, as evidenced by a return of the papilloedema, however the headaches did not recur whilst treated with erenumab.
Conclusions: Those with prior IIH who have their headaches successfully treated with CGRP therapy, should remain under close ocular surveillance (particularly when weight gain is evident) as papilloedema can re-occur in the absence of headache. These cases may suggest that CGRP could be a mechanistic driver for headache in patients with active IIH.
Citation
Yiangou A, Mitchell JL, Vijay V, Grech O, Bilton E, Lavery GG, Fisher C, Edwards J, Mollan SP, Sinclair AJ. Calcitonin gene related peptide monoclonal antibody treats headache in patients with active idiopathic intracranial hypertension. J Headache Pain. 2020 Sep 25;21(1):116. doi: 10.1186/s10194-020-01182-7.
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Article