Use of Calcitonin Gene-Related Peptide Monoclonal Antibody Agents for the Treatment of Chronic or Episodic Migraine in Patients with Multiple Sclerosis

Background: Migraine, a type of headache disorder, is a common comorbidity and source of disability in patients with chronic inflammatory diseases like Multiple Sclerosis (MS). Its prevalence among this group is reported to be as high as 67%. In recent years, the new therapeutic agents for episodic and chronic migraine known as Calcitonin Gene-Related Peptide (CGRP) inhibitors, have shown to effectively control migraine attacks and improve quality of life in the general population. However, to our knowledge, there are no studies exploring the use of these novel agents in patients with comorbid migraine and MS.

Objectives: To evaluate the use, clinical efficacy and safety of CGRP monoclonal antibody therapy for chronic or episodic migraine in patients with MS.

Methods: Retrospective, population-based cohort study evaluating patients with both MS and episodic or chronic migraine seen in the neurology clinic at the University of South Florida Morsani College of Medicine.

Results: In our search, we found a total of 27 MS patients with chronic or episodic migraine who received treatment with a CGRP monoclonal antibody. Of these, 63% of patients reported greater than 75% reduction in their migraine frequency. 82% of patients had co-treatment with a disease modifying therapy for their MS, in which 37% was also a monoclonal antibody therapy. 11% of patients reported mild adverse effects from CGRP monoclonal antibody therapy and no patient demonstrated worsening of their MS during co-treatment.

Conclusions: To our knowledge, this is the first study evaluating the use and clinical efficacy of CGRP monoclonal antibody therapy for chronic or episodic migraine in patients with MS. Our study shows similar efficacy as in the general population with significant reduction in the frequency of migraine attacks and a relatively safe side effect profile. While CGRP pathway inhibition may induce a pro-inflammatory state, none of the patients in this study demonstrated worsening of their MS. In conclusion, CGRP monoclonal antibody agents for episodic or chronic migraine seem to be a safe and effective therapy for patients with comorbid MS and migraine.