The Use of Anti-CGRP Medications for Management of Intractable Chronic Daily Headaches in the Pediatric Population: Case Series and Literature Review

BackgroundChronic daily headaches are the cause of significant morbidity in adolescents. Many patients with migraine show minimal response to daily preventive medications and often have significant side effects. Calcitonin gene-related peptide (CGRP) inhibitors have been found to be effective for managing migraines in the adult population. However, limited data are available for their use in pediatrics.MethodsSingle-center retrospective case series of all consecutive patients (<18 years) treated at the outpatient pediatric neurology clinic at Children's Hospital of Illinois/Illinois Neurological Institute between 2020 and 2023. Data extracted from the electronic medical record included demographics, comorbidities, headache characteristics, including the Headache Impact Test-6 (HIT-6) score, and Pediatric Migraine Disability Assessment (PedMIDAS) score. The study was approved by the Institutional Review Board, and informed consent from all patients was obtained.ResultsDetails of 8 patients treated with CGRP inhibitors are provided. Median age of the cohort was 17.2 years, and 62.5% were female. The median number of 6.5 medications were tried before CGRP inhibitors. Median Headache Impact Test-6 and Pediatric Migraine Disability Assessment scores were 76 and 40, respectively, and they decreased to a median of 36 and 5, by the last reported visit of each patient. All patients responded to the therapy, with 7 of 8 responding within 3 months (50% decrease of MIDAS score). One patient was co-treated with Botox injections and also with as-needed use of CGRP receptor blockers. No significant adverse events were reported by any patient.ConclusionOnce a month, anti-CGRP injections are effective and well tolerated in the pediatric population. CGRP inhibitor therapy may be a reasonable therapeutic option for managing chronic daily headaches in patients who have failed other routine prophylactic medication management.