Calcitonin gene related peptide monoclonal antibody treats headache in patients with active idiopathic intracranial hypertension

Research output: Contribution to journalArticlepeer-review

Authors

  • James Mitchell
  • Vivek Vijay
  • Olivia Grech
  • Edward Bilton
  • Claire Fisher
  • Julie Edwards
  • Susan Mollan

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.

Details

Original languageEnglish
Article number116
Number of pages8
JournalThe Journal of Headache and Pain
Volume21
Issue number1
Publication statusPublished - 25 Sep 2020

Keywords

  • CGRP monoclonal antibody, Headache, Idiopathic intracranial hypertension, Papilloedema, Raised intracranial pressure