CGRP Antibody Completely Stopped Migraine Auras in a Patient Who Had Them Without Headaches for 39 Years | Research

The takeaway

A single dose of galcanezumab completely resolved migraine auras without headache in a 49-year-old woman who had experienced them since age 10, suggesting CGRP antibodies may treat this underserved migraine subtype.

Complete resolution in 1 day
39 years of migraine aura without headache resolved after first galcanezumab injection

What the researchers found

Galcanezumab completely prevented migraine aura without headache within one day of first administration in a patient with a 39-year history of the condition.

Why it matters

Migraine aura without headache is an underrecognized condition with limited treatment options. CGRP antibodies are currently only approved for migraines with and without aura (but with headache). This case suggests they could help a group of patients who have been largely overlooked.

The numbers in context

49-year-old female, history since age 10 (39 years). Photosensitivity and typical migraine auras without headache.

How the study worked

Single case report documenting the clinical response of a 49-year-old female patient with migraine aura without headache to galcanezumab 120mg monthly.

Who was studied

49-year-old female with migraine aura without headache since age 10

What this study cannot tell us

Single case report — cannot establish efficacy for the broader population with migraine aura without headache. The rapid onset (1 day) is unusual and may not be typical. Placebo effect cannot be ruled out without a controlled trial. Long-term outcomes not reported.

How to read the evidence

Preliminary evidence from a single case report. Compelling clinical observation but requires controlled trials to confirm efficacy in this migraine subtype.

When this study was published

Published in 2024. Opens a new potential indication for CGRP antibodies that has not been studied in clinical trials.

The bigger picture

This case expands our understanding of CGRP's role in migraine pathophysiology. The fact that blocking CGRP stopped auras even without associated headache suggests that CGRP is involved in the aura mechanism itself, not just the pain phase. This could lead to expanded indications for CGRP antibodies.

Questions still open

Would other CGRP antibodies (erenumab, fremanezumab) be equally effective for migraine aura without headache?
What is the mechanism by which CGRP blockade prevents the aura phenomenon specifically?
Is the rapid onset seen in this case reproducible in other patients with the same condition?

Common questions

What is migraine aura without headache?

It's a migraine subtype where patients experience the visual disturbances and sensory symptoms (aura) typically associated with migraine, but without the headache phase. Patients may see zigzag lines, flashing lights, or have temporary vision changes and light sensitivity.

Are CGRP antibodies approved for this type of migraine?

Not specifically. CGRP antibodies like galcanezumab are currently approved for preventing migraines with and without aura, but the approvals assume headache is present. This case report suggests they might also work for aura without headache, but formal clinical trials are needed.

Read the original research

Anti-Calcitonin Gene-Related Peptide Monoclonal Antibody Is Effective for Preventing Migraine Aura Without Headache.

Neurology international, 16(6), 1279-1284

View on PubMed ↗Publisher’s paper ↗

Citation

Shibata, Yasushi. (2024). Anti-Calcitonin Gene-Related Peptide Monoclonal Antibody Is Effective for Preventing Migraine Aura Without Headache.. Neurology international, 16(6), 1279-1284. https://doi.org/10.3390/neurolint16060097