Background
Individuals with chronic migraine (CM) frequently use acute headache medications, including triptans, ergot derivatives, opioids, and simple and combination analgesics, which can result in medication overuse (MO) [1, 2] and lead to greater disability and further reduced quality of life [1–5]. Preventive migraine therapy is recommended in patients with failure or overuse of acute medication, frequent attacks (≥4 headache days per month), headaches that interfere with daily routines despite acute treatment, or adverse events associated with acute treatments [3, 6]. Despite the potential benefits, preventive therapy is often underutilized [7, 8, 9], and persistence with treatment is often poor due to lack of efficacy or intolerable side effects [10–12]. New preventive therapies may improve patient lives with superior treatment efficacy and tolerability compared with previously available migraine preventive therapies [12, 13].
Fremanezumab, a fully humanized monoclonal antibody (IgG2∆a) that selectively targets calcitonin gene-related peptide (CGRP), is approved in the United States and the European Union for the preventive treatment of migraine in adults [14, 15]. The 12-week, double-blind, placebo-controlled, phase 3 HALO CM trial demonstrated that subcutaneous administration of fremanezumab significantly reduced headache days of at least moderate severity in patients with CM [16]. To understand the impact of fremanezumab in patients with MO, data from patients with CM with and without MO were assessed post hoc to examine the reduction of headache and migraine days and acute headache medication use. Outcomes were also examined in patients who either did or did not revert from MO at baseline to no MO during the study.