Abstract Details

Approximately two-thirds of patients with IIH continue to have headaches following normalization of their CSF pressure. For many, the headache phenotype is migraine. CGRP plays a key role in migraine pathophysiology but its role in post-IIH headache is uncertain.

To determine the effectiveness of anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies in treating persistent headaches following resolution of papilledema in patients with Idiopathic Intracranial Hypertension (IIH).

Retrospective chart review of patients treated from May 2018 to January 2020 with an established diagnosis of IIH and previous or current use of an anti-CGRP monoclonal for treatment of post-IIH headache. The primary outcome was a reduction in the mean decrease in monthly headache days (MHD) by at least 50% compared to baseline. Secondary outcomes assessed whether, on average, the change in the number of MHD decreased by at least 25%, 75%, or 100% compared to baseline.

24 of the 79 charts reviewed met inclusion criteria. Most patients were women 23/24 (95.8%) and Caucasian 18/24 (75%). Mean MHD at baseline was 24.39 (SD 7.35) and baseline MIDAS score of 88.39 (SD 63.58) indicating severe disability. The average number of previously tried preventive medications was 5.87 (SD 2.82) and 62.5% had documented medication overuse headache. Half of the patients (12/24) had a prior history of migraine. All three subcutaneous CGRP monoclonal antibodies were used: galcanezumab 10/24 (41.7%), erenumab 9/24 (37.5%), and fremanezumab 4/24 (16.7%). No statistical difference in the relative change in MHD at 3 months (95% CI: -0.05, 0.44) or 6 months (95% CI: -0.95, 0.59) post baseline was demonstrated. The secondary endpoint was not met.

CGRP monoclonal antibodies did not yield significant reductions in MHD in our patient population. The treatment of persistent headaches in patients with IIH warrants further study.