In recent years, several specific drugs have been approved for the prevention of migraine. Even so, at the first symptoms of migraine, non-specific medications are still prescribed. They have not been designed for migraine and have little efficacy. Two international studies led by the Headache and Neurological Pain group at Vall d'Hebron Research Institute (VHIR) show that early administration of specific drugs to prevent migraine improves the response to therapy and can prevent disease progression. The results have been recently published in the journals JAMA Neurology and Journal of Neurology, Neurosurgery and Psychiatry.

Targeted medication improves patients' quality of life

Among the drugs designed specifically for the treatment of migraine, noteworthy are those aimed at blocking the CGRP protein, which is related to the pain associated with the pathology. These include erenumab, the first drug in this group to commercialize.

To assess the benefits of specific medication against migraine, the first of the studies, published in JAMA Neurology, analyzed the evolution of 621 patients with episodic migraine, i.e., who had less than 15 days of migraine per month. The work consisted of a phase IV clinical trial involving 84 centers in 17 countries. The patients were classified into two groups: one group received the drug erenumab and the other received non-specific medications to prevent migraine, such as beta-blockers, antiepileptic drugs, antidepressants, etc.

The researchers observed that the patients receiving erenumab responded better to treatment. In fact, the study shows that, if a patient receives erenumab, they are up to 13 times more likely to have a clinically relevant improvement after one year compared to if they receive non-specific treatment.

This study also sought to simulate clinical practice and allowed neurologists to change the treatment of patients when necessary. In this sense, patients receiving erenumab maintained the treatment more frequently than those initially receiving nonspecifics. They also had fewer side effects. "Erenumab proves to be more effective and tolerable and also significantly improves patients' adherence to treatment", explains Dr. Patricia Pozo-Rosich, head of Section of the Neurology Service and Headache Unit at Vall d'Hebron University Hospital, head of the Headache and Neurological Pain group at VHIR and director of the Migraine Adaptive Brain Center at Vall d'Hebron.

In relation to the evolution of the disease, taking the specific treatment in early stages can prevent the development of chronic migraine, in which patients have more than 15 migraine days per month. "When you start treatment late, it's much harder to reverse. If we do early treatments, we can decrease chronification. Therefore, it would be advisable to prescribe them as the first line to prevent chronic migraine and improve the quality of patients, reduce disability and reduce the associated socioeconomic costs", Dr. Pozo-Rosich emphasizes.

The earlier the treatment is started, the better the results are obtained

Despite the revolution that anti-CGRP drugs have meant for migraine therapy, there is still a large percentage of people who do not achieve clinical improvement. Vall d'Hebron has led a study, published in the Journal of Neurology, Neurosurgery and Psychiatry, to investigate which variables influence the response to therapy. The work, carried out in nearly 6,000 people from 35 centers and 7 European countries, analyzed the factors that influence response to anti-CGRP therapies. It is a real-life study with patients who had previously received non-specific drugs and had no response, and who at the time of the study were taking anti-CGRP drugs, such as erenumab, among others.

Key factors favoring response to therapy included having fewer migraines per month or less disease-associated disability. "The results underline the importance of starting treatment early to improve the evolution of the disease, without waiting for other non-specific drugs to be ineffective", says Dr. Edoardo Caronna, neurologist at the Headache Unit of the Vall d'Hebron University Hospital and principal investigator of the Headache and Neurological Pain group at VHIR.

On the other hand, the team observed that there were other factors associated with a better response to treatment, such as having pain on only one side of the head or not suffering from depression. In addition, although the sex of the person did not influence the response, a better response was observed in older people.

“All these factors help us understand why some patients respond or not, but we need to continue research to have specific biomarkers for the diagnosis, follow-up, and response to migraine treatment that will allow us to identify people who will respond to therapy before taking it", concludes Dr. Pozo-Rosich, who assures that personalized medicine will help achieve a better quality of life in patients with this neurological disease that can be very disabling.