背景降钙素基因相关肽拮抗剂为偏头痛的治疗提供了新的途径。他们的效用在严重形式的慢性偏头痛患者是一个特别有趣的课题。我们对一组难以控制的慢性偏头痛患者进行了为期9个月的厄伦单抗治疗，这些患者之前对肉毒杆菌毒素的反应都不满意。

方法对98例对肉毒杆菌毒素反应不满意的患者进行二烯单抗治疗。98例中有80例进行了枕大神经注射（82%）、32/98外周神经刺激（33%）和18/98静脉注射二氢麦角胺（18%）。98例中有38例（39%）符合曲普坦过度使用的定义，43/98例（44%）符合止痛药过度使用的定义。所有患者均符合EHF的“难治性偏头痛”标准。结果测量（每月记录）包括头痛限制日常生活活动的天数（“红色”），不限制（“琥珀色”），无头痛（“绿色”），以及需要曲普坦或其他镇痛药。生活质量评分-头痛冲击试验6（HIT-6），患者健康问卷9（PHQ-9）和疼痛残疾指数（PDI）-也进行了测量。

结果3个月时平均红天数增加6.4天（SE0.67，95%CI 7.7～5.1，p=0.001），6个月时平均红天数增加6.8天（SE0.96，95%CI 8.80～4.9，p=0.001），9个月时平均红天数增加6.5天（SE0.86，95%CI 8.3～4.8，p=0.001）。重复测量方差分析证实，在整个研究期间，红色（p=0.001）、绿色（p=0.001）、曲普坦（p=0.001）和止痛药日数（p=0.001）以及HIT-6（p=0.001）、PHQ-9（p=0.001）和PDI（p=0.001）评分均有改善。

结论应用二烯单抗治疗对肉毒杆菌毒素耐药的慢性偏头痛患者，其疼痛、用药和生活质量均有改善。

 Improvements in pain, medication use and quality of life in onabotulinumtoxinA-resistant chronic migraine patients following erenumab treatment - real world outcomes.
Talbot J,et al J Headache Pain 2021 Jan 09
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Abstract 翻译

BACKGROUND The CGRP antagonists offer a novel therapeutic approach in migraine. Their utility in patients with severe forms of chronic migraine is a subject of particular interest. We present outcomes of 9 months of erenumab treatment in a cohort of patients with difficult-to-control chronic migraine, all of whom had prior unsatisfactory response to onabotulinumtoxinA.
METHODS We offered erenumab to 98 patients with a prior unsatisfactory response to onabotulinumtoxinA. Eighty of 98 had trialled greater occipital nerve injections (82%), 32/98 peripheral neurostimulation (33%) and 18/98 intravenous dihydroergotamine (18%). Thirty eight of 98 (39%) met the definition of triptan overuse and 43/98 (44%) analgesic overuse. All patients met the EHF criteria for 'resistant migraine'. Outcome measures (recorded monthly) included days with headache limiting activities of daily living ("red"), not limiting ("amber"), headache free ("green"), and requiring triptans or other analgesics. Quality of life scores - headache impact test 6 (HIT-6), patient health questionnaire 9 (PHQ-9) and pain disability index (PDI) - were also measured.
RESULTS Mean number of red days improved by - 6.4 days (SE 0.67, 95%CI - 7.7 to - 5.1, p=0.001) at 3 months; - 6.8 days (SE 0.96, 95%CI - 8.80 to - 4.9, p=0.001) at 6 months and - 6.5 days (SE 0.86, 95%CI - 8.3 to - 4.8, p=0.001) at 9 months. Repeated measures ANOVA confirmed improvements in the number of red (p=0.001), green (p=0.001), triptan (p=0.001) and painkiller days (p=0.001) as well as scores of the HIT-6 (p=0.001), PHQ-9 (p=0.001), and PDI (p=0.001) across the duration of study.
CONCLUSION We observed improvements in pain, medication use and quality of life in onabotulinumtoxinA-resistant chronic migraine patients following erenumab treatment.