AUTHOR=Schiano di Cola Francesca , Ceccardi Giulia , Bolchini Marco , Caratozzolo Salvatore , Liberini Paolo , Padovani Alessandro , Rao Renata 

TITLE=Photophobia and migraine outcome during treatment with galcanezumab

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.1088036

DOI=10.3389/fneur.2022.1088036

ISSN=1664-2295

ABSTRACT=BACKGROUND: Calcitonine gene-related peptide (CGRP) plays a pivotal role in migraine physiology, not only regarding migraine pain but also associated symptoms as photophobia. Aim of the present study was to assess monoclonal antibodies targeting CGRP efficacy not only in terms of headache and migraine frequency and disability, but also in reducing ictal photophobia.
MATERIAL AND METHODS: this is a retrospective observational study, conducted at the Headache Centre – ASST Spedali Civili Brescia. All patients in monthly treatment with galcanezumab with at least a 6 months follow-up at september 2022 with reported severe photophobia during migraine attacks were included. Data regarding headache frequency, analgesics consumption and migraine disability were collected quarterly. Moreover, patients were asked the following information regarding photophobia: (1) whether they noticed an improvement in photophobia during migraine attacks since galcanezumab introduction; (2) the degree of photophobia improvement (low, moderate, high); (3) timing photophobia improvement. 
RESULTS: Fourty-seven patients were enrolled in the present study as they met the inclusion criteria. Seventeen patients had a diagnosis of high frequency episodic migraine and 30 of chronic migraine. From baseline to T3 and T6, a significant improvement in terms of headache days (19.2±7.6 vs 8.6±6.8 vs 7.7±5.7; p<0.0001), migraine days (10.4±6.7 vs 2.9±4.3 vs 3.6±2.8; p<0.0001), analgesics consumption (25.1±28.2 vs 7.6±7.5 vs 7.6±8.1; p<0.0001), MIDAS score (82.1±48.4 vs 21.6±17.6 vs 18.1±20.5; p<0.0001) and HIT-6 score (66.2±6.2 vs 57.2±8.6 vs 56.6±7.6; p<0.0001) was found. Thirty-two patients (68.1%) reported a significant improvement of ictal photophobia, with over half of the patients reporting it within the fist month of treatment. Photophobia improvement was more frequent in patients with episodic migraine (p=0.02) and triptans responders (p=0.03).
CONCLUSIONS: the present study confirms previous reports regarding galcanezumab efficacy beyond migraine frequency. In particoular, over 60% of patients, in our cohort, documented a significant improvement also in reducing ictal photophobia. This improvement was, in most patients, moderate to high, and within the first six months of treatment, regardless of the clinical response on migraine frequency.