The current study is a post hoc analysis of data from the phase 2 trials assessing fremanezumab in the preventive treatment of HFEM and CM. Here, we take advantage of the phase 2 fremanezumab trials to evaluate its effect on functional performance on headache-free days. 13, – 17 In the trials, patients completed a daily headache calendar in days that they did not experience headaches, patients answered questions focused on functional performance for the day.

Phase 2 and pivotal phase 3 trials assessing its efficacy and safety have been completed for EM and CM. 10, – 12 Accounting for phase-related and interictal nonheadache symptoms, in addition to the symptoms of frequent comorbid diseases, is important in fully describing the burden of migraine.įremanezumab, formerly known as TEV-48125, is a fully humanized immunoglobulin G2a monoclonal antibody that potently and selectively binds to calcitonin gene-related peptide (CGRP), thereby preventing its binding to receptors. 7, – 9 Prodrome and postdrome symptoms are indeed common, affecting up to 80% of the migraine population.

Rather than the conventional view of migraine as an episodic or paroxysmal headache disorder with attacks that are divided into discrete phases in between which patients are symptom-free, migraine may be best conceptualized as a chronic neurologic disorder with persistent interparoxysmal physiologic compromise, exemplified by persistent symptoms punctuated by recurrent attacks of headache and other attack-related symptoms that may include overlapping phases of prodrome (commonly referred to as premonitory), aura, headache, and postdrome. In a recent large study 6 investigating 2,959 patients with EM, 10.6% reported interictal anxiety, 14.8% reported avoidance and lifestyle compromise, and 26% reported interictal symptoms.

Headache-related disability may incompletely capture the burden of migraine because growing evidence suggests that the effect of migraine extends beyond the headache. 1, – 4 On the basis of disability associated with the headache attacks, migraine is ranked seventh highest among medical causes of disability worldwide. Episodic migraine (EM) affects 12% of the general population, and ≈1% of the general population experiences chronic migraine (CM), defined as headaches occurring on at least 15 d/mo, with at least 8 days of migraine per month.

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