Nine-Month Continuous Fremanezumab Prophylaxis on the Response to Triptans and Also on the Incidence of Triggers, Hypersensitivity and Prodromal Symptoms of Patients with High-Frequency Episodic Migraine

Emmanouil V Dermitzakis; Michail Vikelis; Georgia Xiromerisiou; Dimitrios Rallis; Panagiotis Soldatos; Pantelis Litsardopoulos; Dimitrios Rikos; Andreas A Argyriou

doi:10.3390/jcm13020386

Nine-Month Continuous Fremanezumab Prophylaxis on the Response to Triptans and Also on the Incidence of Triggers, Hypersensitivity and Prodromal Symptoms of Patients with High-Frequency Episodic Migraine

J Clin Med. 2024 Jan 10;13(2):386. doi: 10.3390/jcm13020386.

Authors

Emmanouil V Dermitzakis¹, Michail Vikelis², Georgia Xiromerisiou³, Dimitrios Rallis⁴, Panagiotis Soldatos⁵, Pantelis Litsardopoulos⁶, Dimitrios Rikos⁷, Andreas A Argyriou⁶

Affiliations

¹ Euromedica General Clinic, 54645 Thessaloniki, Greece.
² Headache Clinic, Mediterraneo Hospital, 16675 Athens, Greece.
³ Department of Neurology, University Hospital of Larissa, University of Thessaly, 41110 Larissa, Greece.
⁴ Department of Neurology, Tzaneio General Hospital of Piraeus, 18536 Athens, Greece.
⁵ Independent Researcher, 24100 Kalamata, Greece.
⁶ Headache Outpatient Clinic, Department of Neurology, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece.
⁷ 404 Military Hospital, 41222 Larisa, Greece.

Abstract

Objective: To investigate whether the incidence of triggers, prodromal symptoms, hypersensitivity symptoms accompanying headache and responses to triptans were modified during a continuous 9-month fremanezumab therapy for migraine prophylaxis. Patients and methods: We studied 63 patients with high-frequency episodic migraine (HFEM). Enrolled patients received fremanezumab for nine consecutive months before defining the response rates and being stratified into treatment responders (≥50-74% reduction in monthly headache days (MHDs)), super responders (≥75%), partial non-responders (<50%) and super non-responders (<30%). Through headache diaries, patients provided data in order to document the impact of fremanezumab on the incidence of triggers, associated symptoms followed by headache and response to triptans (the use of the migraine treatment optimization questionnaire-4 (mTOQ-4)) during the 9-month treatment period. Results: Fremanezumab had early (after 3 monthly cycles) beneficial effects on the response to triptans in the majority of responders with relevant increases in mTOQ-4 scoring, but also in half of partial non-responders. A significant reduction in median days with migraine-associated symptoms was seen in responders after 6 months of therapy with fremanezumab, mostly for osmophobia, photophobia, phonophobia and nausea/vomiting, but partial non-responders also benefited. Likewise, the incidence of self-reported prodromal symptoms was significantly reduced in responders and was modestly diminished in partial non-responders. Triggers remained unaffected in both responders and non-responders. Conclusions: Fremanezumab given for at least 6-9 months may exert neuromodulatory effects in the migraine brain. These effects could result both in the inhibition of migraine chronification, but also in the diminishing of the magnitude of migraine-associated symptoms, mostly in responders and in partial non-responders.

Keywords: effects; fremanezumab; hypersensitivity symptoms; prodromal symptoms; response to triptans; triggers.

Grants and funding

This research received no external funding.