Erenumab successfully treated symptoms of idiopathic intracranial hypertension (IIH) headaches, according to study results published in published in Headache.
Headache largely influences disability in IIH. This study sought to evaluate the effectiveness of erenumab for the treatment of headaches in patients with IIH whose papilledema resolved.
Study researchers from the University of Birmingham in the United Kingdom conducted a prospective study, recruiting women (N=55) with IIH in ocular remission who experienced chronic migraine-like headaches (³15/month) between October 2018 and August 2019. Patients self-administered 70-mg 4-weekly injections of erenumab. Every 3 months, study researchers reviewed patients’ headache diaries, IIH symptoms and Headache Impact Test (HIT-6). Additionally, they reviewed patients’ Medical Outcomes Study Short Form Health Survey at baseline, 6 months, and 12 months.
The participants were aged mean 35.3 (standard deviation [SD], 9) years, had experienced headaches for an average 1.7 (SD, 2.5) years after their papilledema was resolved, and had 29.0 (SD, 2.3) mean headache days per month. The average headache severity was high (6 out of 10; SD, 1.3) and impacted daily life (HIT-6, 67.2; SD, 4.4). Nearly half of participants had medication overuse headache (48%) and family history of migraine (44%).
At 3 months, 87 percent of participants required an erenumab dose increase and 11 percent continued with the 70-mg dose. By month 12, 4 percent remained on the 70-mg dose, 94 percent were given 140 mg, and 15 percent discontinued erenumab therapy (ineffective treatment [n=6], pregnancy [n=1], noncompliance [n=1]).
At study conclusion, the reduction of moderate to severe headache days was -10.8 (95% CI, -9.5 to -11.9; P <.001) and that of total monthly headache days was -13.0 (95% CI, -10.2 to -15.7; P <.001). Most patients (85%) achieved a 50% reduction of moderate to severe headache days and 54% reported a 50% reduction of total headache days.
Headache severity reduction was -1.3 (95% CI, -0.9 to -1.9; P <.001) points. Additionally, days of analgesic use decreased by -4.3 (95% CI, -1.6 to -6.9; P =.002) at 12 months. Disability due to headache was significantly reduced at 12 months (HIT-6, 59.7; SD, 8.6; P <.001) compared with baseline (HIT-6, 67.4; SD, 4.4; P <.001).
Adverse events included constipation (16%), muscle cramps or spasms (11%), skin rash (5%), itching (5%), injection site pain (5%), thinning hair (4%), nasopharyngitis (2%), and acne (2%). Papilledema recured among 7 patients.
This study was limited by excluding the data from non-responders, which likely inflated results.
Study researchers concluded that their findings provide “evidence for the effectiveness of erenumab to treat headaches in IIH patients with resolution of papilledema. It provides mechanistic insights suggesting that calcitonin gene-related peptide is likely a modulator driving headache and a useful therapeutic target.”
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Yiangou A, Mitchell JL, Fisher C, et al. Erenumab for headaches in idiopathic intracranial hypertension: A prospective open-label evaluation. Headache. Published online December 14, 2020 doi:10.1111/head.14026.