Background and Aims:

Migraine ranks as the second leading cause of disability worldwide. Current prophylactic drugs, aiming at reducing disease burden and acute medication intake, are not targeted to migraine, and limited by side effects. Novel antibodies anti-CGRP are preferentially intended for patients with severe phenotype due to their high cost.

We conducted a monocentric, longitudinal, retrospective, cohort study, to evaluate efficacy and safety at 3 months (T1) of different first and second-line prophylactic treatments in a “real life” population, afferent to our tertiary headache centre.

Methods:

We enrolled 294 patients diagnosed with episodic and chronic migraine, with and without aura, according to ICHD-3beta criteria, regardless of age and comorbidity. The primary outcome was reduction in monthly migraine headache days at T1 compared to baseline, defined as ≥ 30% (R30) and ≥50% (R50) reduction. We also collected side effects at T1.

Results:

At T1, 162 patients (55%) achieved R30, while 138 patients (47%) R50. Among the 9 treatments considered, responders were more frequently treated with flunarizine than non-responders (25.9% vs 12.9%, p＜0.006, and 25.4% vs 15.4%, p＜0.04, for R30 and R50 respectively), and with monotherapy (93.8% vs 83.3%, p=0.005, and 93.5% vs 85.2%, p=0.025, for R30 and R50 respectively). Flunarizine had a number needed to treat for R50 of 2.9 and to harm of 8.9.

Conclusions:

Flunarizine showed the best profile regarding efficacy and safety in our population. This result could suggest its use as first line treatment in migraine prophylaxis and preliminary to anti-CGRP antibodies.

Background and Aims:

Migraine ranks as the second leading cause of disability worldwide. Current prophylactic drugs, aiming at reducing disease burden and acute medication intake, are not targeted to migraine, and limited by side effects. Novel antibodies anti-CGRP are preferentially intended for patients with severe phenotype due to their high cost.

We conducted a monocentric, longitudinal, retrospective, cohort study, to evaluate efficacy and safety at 3 months (T1) of different first and second-line prophylactic treatments in a “real life” population, afferent to our tertiary headache centre.

Methods:

We enrolled 294 patients diagnosed with episodic and chronic migraine, with and without aura, according to ICHD-3beta criteria, regardless of age and comorbidity. The primary outcome was reduction in monthly migraine headache days at T1 compared to baseline, defined as ≥ 30% (R30) and ≥50% (R50) reduction. We also collected side effects at T1.

Results:

At T1, 162 patients (55%) achieved R30, while 138 patients (47%) R50. Among the 9 treatments considered, responders were more frequently treated with flunarizine than non-responders (25.9% vs 12.9%, p＜0.006, and 25.4% vs 15.4%, p＜0.04, for R30 and R50 respectively), and with monotherapy (93.8% vs 83.3%, p=0.005, and 93.5% vs 85.2%, p=0.025, for R30 and R50 respectively). Flunarizine had a number needed to treat for R50 of 2.9 and to harm of 8.9.

Conclusions:

Flunarizine showed the best profile regarding efficacy and safety in our population. This result could suggest its use as first line treatment in migraine prophylaxis and preliminary to anti-CGRP antibodies.