What do You think about CGRP antibodies ? A new group of drugs for preventive treatment of patients with episodic or chronic migraine. Are You for or against ? Personaly I'm rather optimistic.
Thank You in advance for Your's valuable comments in this topic.
Human monoclonal antibodies are far too large a molecule to cross the blood brain barrier and appear to work by blocking the inflammatory response process around the meningeal vessels. They thus do not alter the fundamental brain networking pathophysiology, and indeed I have heard reports from other clinicians that the other symptoms can remain but the headache goes
My own thoughts on this are that this may result in a changed classification system moving away from the purely descriptive IHS to one that includes the cause. At the moment there is a somewhat arbitrary distinction between episodic and chronic migraine at 15 days a month but to my mind there is a pathophysiology distinction between a primarily central process which results in a chain reaction that includes pain from inflammatory processes in the meninges but fully resolves, and a primarily inflammatory process that extends beyond the central cyclical processes to that results in some form of chronic inflammatory process in the meninges (and possibly astrocytes within the brain)
I believe that what is presently called chronic migraine is in fact a cyclical process where the attacks are so frequent that one attack has not yet finished before the next one starts, and the episodic element had been submerged by the frequency of attacks, and that this is fundamentally different to a true chronic daily headache that is unremitting and unchanging
MABs such as Erenumab are incredibly expensive and government funding for it in the UK has just been rejected in favour of Botox but I can see that there may be a place for it in the future in some types of truly chronic headaches where Botox has not worked
The other new treatment to consider is Daith Ear Piercing. It passes through the area innervated by the auricular branch of the vagus nerve (ABVN). Vagus nerve stimulation is an established treatment for migraines and epilepsy
Like any other treatment, daith piercing is not effective for all sufferers, but our clinical experiences are that it can be extremely effective in about 50% of patients (including those who have failed other therapies) with about 10% reporting complete cessation of their migraines for extended periods
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