Quiz Form

Question Date: 03/07/2023

Question: A 40 year old lady has chronic migraine with headache on most days of the month. She has been on Beta blocker, amitriptyline, topiramate and sodium valproate in various combination in the past without relief. She does not take triptan or NSAIDS as there is no relief. A CGRP monoclonal antibody has been started<br><br>Which statement is true regarding this treatment?

Options:

• CGRP monoclonal antibody would provide modest relief at best
• CGRP monoclonal antibody cannot be used for long term
• Long term side effects are not known and are evolving
• CGRP monoclonal antibodies are safe in pregnancy at present

Correct Answer: Long term side effects are not known and are evolving

Explaination: Calcitonin Gene-Related Peptide (CGRP) monoclonal antibodies are effective treatment for both episodic and chronic migraine. They include antibody to CGRP (Galcanezumab, Fremanezumab, Eptinezumab) or its receptor (Erenumab) Advantages include high efficacy, potentially less side effects and convenient dosage. The 50% responder rate for these molecules were in the range of 50-60%. Long term response over 1-3 years has been reported. At present, they are contraindicated in pregnancy and breastfeeding and optimal interval to wait before attempting pregnancy is not known. As CGRP has several physiological effects in the body, long term side effects are evolving. For example severe constipation and development of hypertension were seen with erenumab.

Reference: Burch R. Preventive Migraine Treatment. Continuum 2021;27(3 headache):613-632