Prognostic value of personality traits in response to anti-CGRP monoclonal antibodies in patients with refractory migraine

INTRODUCTION: The purpose of this study is to determine whether certain personality traits may predict response to anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) in patients with migraine. METHODS: We conducted an observational, prospective study of a cohort of patients with chronic migraine (CM) or high-frequency episodic migraine (HFEM) treated with anti-CGRP mAbs according to Spanish national healthcare system reimbursement criteria at the headache unit of a tertiary hospital. We gathered clinical and demographic data. Treatment response was defined as a ≥ 50% decrease in the number of headache days per month at 3 months of treatment. The Salamanca Screening Test was used to evaluate personality traits. RESULTS: We included 104 patients, 88 of whom were women (84.6%), with a mean age (standard deviation) of 46.5 years (10.3) at treatment onset. A total of 88 patients (84.6%) had a diagnosis of CM. Fifty-two patients received galcanezumab and the remaining 52 were treated with fremanezumab. Response was achieved in 75 patients (72.1%). Compared to non-responders, responders presented a younger age at treatment onset (44.1 [10.6] vs 49.7 [9.1]; P = .006), shorter latency from migraine onset to treatment onset (22.4 [12.2] vs 28.2 [14.4] years; P = .029), and shorter latency from CM or HFEM diagnosis to treatment onset (90.4 [51.9] vs 118.5 [61.2] months; P = .013). The most prevalent personality traits in our sample were histrionic (64.4%), anankastic (52.9%), and anxious (50%). Borderline personality was found to predict lack of response to treatment (OR = 0.24 [0.09-0.64]). CONCLUSIONS: Personality traits, along with other clinical and demographic variables, may predict response to treatment with anti-CGRP mAbs in patients with migraine.