Locking down the CGRP pathway during the COVID-19 pandemic lockdown: the PandeMig study

Objectives The COVID-19 pandemic and the consequent lockdown came as a storm disrupting people's everyday life. This study aimed at observing whether the COVID-19 related lockdown influenced migraine frequency and disability in migraine patients on therapy with monoclonal antibodies inhibiting the CGRP pathway. Methods In this longitudinal observational cohort study, 147 consecutive patients receiving monthly administration of erenumab or galcanezumab were enrolled in four Italian headache centers. All patients filled a questionnaire concerning working and household settings, recent flu symptoms or COVID-19 diagnosis, and family loss due to COVID-19 infection. Monthly migraine days (MMDs), monthly painkiller intake (MPI), and HIT-6 disability relative to the first month of lockdown imposition (T-lock) and the month before (T-free) were also collected. Results From T-free to T-lock, the cohort displayed a reduction in MMDs (from 10.5 +/- 7.6 to 9.8 +/- 7.6,p= .024) and HIT-6 scores (from 59.3 +/- 8.3 men reduced MPI more frequently than women (p= .005). Conclusions Our study observed that the lockdown impact to 57.8 +/- 8.8,p = .009), while MPI resulted unchanged (from 11.6 +/- 11.5 to 11.1 +/- 11.7;p= .114). MMDs, MPI, and HIT-6 variations from T-free to T-lock did not differ according to work settings or household. Patients beyond the first 3 months of therapy presented less often a reduction in MMDs (p= .006) and on everyday life did not affect the migraine load in patients receiving monoclonal antibodies inhibiting the CGRP pathway. Patients in the first months of therapy experienced a greater improvement according to drug pharmacokinetics, while women more frequently needed rescue medications, possibly indicating presenteeism or cephalalgophobia.