Migraine is characterized by an intense throbbing and pulsating headache that can be accompanied by other symptoms, such as photophobia, gastrointestinal disturbances, etc., and is considered the sixth most disabling disease according to the World Health Organization (WHO). In Spain, more than five million people suffer from migraine and, in fact, it is the most prevalent neurological disease in our country, according to the Spanish Society of Neurology (SEN), which also indicates that more than 50% of patients with migraine have a degree of severe or very severe disability.
The prevalence of migraine is lower in those over 65 years of age, but if they suffer from other diseases or the pain becomes chronic, limitations may occur in the prescription and responses to treatment, so that migraine significantly affects their quality of life and It supposes an almost complete disability because together with the headache they can experience intolerance to external stimuli and to physical activity and nausea.
Now, a study led by the Bellvitge University Hospital (HUB) and the Neurological and Neurogenetic Diseases Research Group of the Bellvitge Biomedical Research Institute (IDIBELL) has resolved doubts about the safety and efficacy of a treatment for migraine in adults and has opened up new possibilities to improve the quality of life of these patients.
After six months of treatment with any monoclonal antibody, patients have gone from an average of eighteen migraine days per month to only eight
“Migraine is a genetic disease that can be cured and that fluctuates throughout life. In elderly patients where it has not been possible to adequately control migraine, there is a greater risk of chronification due to the time of evolution, due to having failed more preventive treatments and due to associated comorbidity”, explained Dr. Albert Muñoz-Vendrell, neurologist at the Headache Unit of the Hospital de Bellvitge and researcher at IDIBELL.
“The hypothesis was that they could suffer from more safety problems, since CGRP is a vasodilator and theoretically if the protein is blocked, there could be an increased cardiovascular risk in elderly patients with hypertension, dyslipidemia, or a history of previous cardiovascular events,” according to the neurologist at the Hospital de Bellvitge. This latest study clears up the pending doubts about these treatments that extend the current approach to migraine, with good tolerance and safety.
More drugs against chronic migraine in people over 65
In the new investigation, 18 Headache Units from hospitals throughout the State have participated and have verified that anti-CGRP drugs are also effective and safe in people over 65 years of age. Anti-CGRP antibodies are drugs available since 2019 that work by blocking CGRP, a protein involved in the pain and vasodilatation processes associated with migraine.
Due to their specific action on the protein, they are very well tolerated and effective drugs without side effects –with the exception of constipation, because the protein is also found in the neurons of the gut–, since they block the pain pathway associated with migraine. However, in clinical trials of monoclonal antibodies, people over 65 years of age had been excluded, so until now it was unknown if they were as effective and safe as in younger migraineurs.
The results of the new study have been published in the scientific journal The Journal of Headache and Pain and reveal that 60% of patients have presented a reduction of more than 50% in the number of days they suffered from migraine. A real life observational study has been carried out with a group of 162 patients, 74.1% of whom were women.
After six months of treatment with any monoclonal antibody (erenumab, galcanezumab and fremanezumab), patients have gone from an average of eighteen migraine days per month to just eight, results that are comparable to the effects of the antibodies that were already known. monoclonals in the general population. Regarding adverse effects in those over 65 years of age, fewer have been detected with the administration of fremanezumab.
The researchers have also verified that the frequency of headaches and the consumption of analgesics in the group of patients who have participated in the study led by the Hospital de Bellvitge have been significantly reduced and that the clinical evaluation scales have improved.
Source: Bellvitge University Hospital (HUB)
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