Improvement of perimenstrual headache after adjustment of anti-CGRP monoclonal antibody dosing schedules based on the menstrual cycle: two case reports

Abstract

　In women with menstrual-related migraine, headache around menstruation may persist despite treatment with anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies. When menstruation coincides with the late phase of the dosing interval, the so-called wearing-off phenomenon may occur and headache may worsen. We report two cases in which adjustment of anti-CGRP monoclonal antibody dosing schedules based on the menstrual cycle improved perimenstrual headache. In the patient with a stable menstrual cycle, the injection schedule was adjusted to before menstruation, whereas in the patient with an irregular cycle, the regimen was changed from monthly to quarterly administration, resulting in reductions in monthly headache days and improvements in HIT-6 scores in both cases. These cases suggest that adjustment of dosing schedules according to the menstrual cycle may enhance treatment efficacy in selected patients.