Abstract
Migraine is a common condition in mitochondrial diseases, with a higher prevalence than in the general population. Although several clinical studies support the hypothesis that mitochondrial dysfunction plays a central role in the pathophysiology of migraine, currently there are few data in the literature regarding the efficacy and safety of drugs for the treatment and prophylaxis for this condition in patients with primary mitochondrial disorders. We report a 37-year-old woman affected by mitochondrial disease with progressive external ophthalmoplegia phenotype (PEO) associated with POLG mutation effectively treated with erenumab, in the absence of side effects. Monoclonal antibodies against the calcitonin gene-related peptide (CGRP) or against its receptor are innovative and specific therapies for migraine prophylaxis. This class of drugs is particularly suitable for subjects, such as those suffering from genetically determined mitochondrial dysfunction, in which pharmacological management can represent a challenge due to the nature of these neurogenetic disorders and/or the frequently associated comorbidities.
This is a preview of subscription content, log in via an institution to check access.
Data availability
The data that support the findings of this study are available from the corresponding author, upon reasonable request.
Change history
26 October 2022
A Correction to this paper has been published: https://doi.org/10.1007/s10072-022-06462-5
Abbreviations
- PEO:
-
Progressive external ophthalmoplegia
- CGRP:
-
Calcitonin gene-related peptide
- MMD:
-
Monthly migraine days
- MOH:
-
Medication overuse headache
- MIDAS:
-
Migraine disability assessment
- HIT-6:
-
Headache impact test-6
- MELAS:
-
Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes
References
Vollono C, Primiano G, Della Marca G, Losurdo A, Servidei S (2018) Migraine in mitochondrial disorders: Prevalence and characteristics. Cephalalgia 38(6):1093–1106. https://doi.org/10.1177/0333102417723568
Gorman GS, Chinnery PF, DiMauro S, Hirano M, Koga Y, McFarland R, Suomalainen A, Thorburn DR, Zeviani M, Turnbull DM (2016) Mitochondrial diseases. Nat Rev Dis Primers 20(2):16080. https://doi.org/10.1038/nrdp.2016.80
Russell OM, Gorman GS, Lightowlers RN, Turnbull DM (2020) Mitochondrial Diseases: Hope for the Future. Cell 181(1):168–188. https://doi.org/10.1016/j.cell.2020.02.051
Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211. https://doi.org/10.1177/0333102417738202
Stewart WF, Lipton RB, Kolodner KB, Sawyer J, Lee C, Liberman JN (2000) Validity of the Migraine Disability Assessment (MIDAS) score in comparison to a diary-based measure in a population sample of migraine sufferers. Pain 88(1):41–52. https://doi.org/10.1016/S0304-3959(00)00305-5
Kosinski M, Bayliss MS, Bjorner JB, Ware JE Jr, Garber WH, Batenhorst A et al (2003) A six-item short-form survey for measuring headache impact: the HIT-6. Qual Life Res 12(8):963–974. https://doi.org/10.1023/a:1026119331193
Tiehuis LH, Koene S, Saris CGJ, Janssen MCH (2020) Mitochondrial migraine; a prevalence, impact and treatment efficacy cohort study. Mitochondrion 53:128–132. https://doi.org/10.1016/j.mito.2020.05.004
Prasad M, Narayan B, Prasad AN, Rupar CA, Levin S, Kronick J et al (2014) MELAS: A Multigenerational Impact of the MTTL1 A3243G MELAS Mutation. Can J Neurol Sci 41(2):210–219. https://doi.org/10.1017/s0317167100016607
Naegel S, Burow P, Holle D, Stoevesandt D, Heintz S, Thaele A et al (2021) Erenumab for migraine prevention in a patient with mitochondrial encephalopathy, lactate acidosis, and stroke-like episodes syndrome: A case report. Headache 61(4):694–696. https://doi.org/10.1111/head.14101
Holzer P, Holzer-Petsche U (2022) Constipation Caused by Anti-calcitonin Gene-Related Peptide Migraine Therapeutics Explained by Antagonism of Calcitonin Gene-Related Peptide’s Motor-Stimulating and Prosecretory Function in the Intestine. Front Physiol 11(12):820006. https://doi.org/10.3389/fphys.2021.820006
Rahman S (2013) Gastrointestinal and hepatic manifestations of mitochondrial disorders. J Inherit Metab Dis 36(4):659–673. https://doi.org/10.1007/s10545-013-9614-2
Andreou AP, Fuccaro M, Lambru G (2020) The role of erenumab in the treatment of migraine. Ther Adv Neurol Disord 27(13):1756286420927119. https://doi.org/10.1177/1756286420927119
Acknowledgements
G. P. and S. S. are members of the European Reference Network for Neuromuscular Diseases-Project ID No. 870177.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
This study was conducted in accordance with the principles of Helsinki Declaration and approved by the Ethics Committee of the Università Cattolica del Sacro Cuore (Rome, Italy). We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.
Consent for publication
We obtained written informed consent from the patient for participation in the study and publication of data.
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The original online version of this article was revised: The original online version of this article was revised due to a retrospective Open Access cancellation.
Rights and permissions
About this article
Cite this article
Primiano, G., Rollo, E., Romozzi, M. et al. Preventive migraine treatment in mitochondrial diseases: a case report of erenumab efficacy and literature review. Neurol Sci 43, 6955–6959 (2022). https://doi.org/10.1007/s10072-022-06391-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-022-06391-3