Migraine is a common disease that significantly negatively affects patients’ quality of life. Previously reported treatments have shown limited efficacy and safety; however, anti-calcitonin gene-related peptide monoclonal antibody (CGRPmAb) has attracted considerable attention as an antimigraine agent. This agent became commercially available in Japan in 2021, only a year before this present review, and research is warranted to gain deeper insight into the outcomes of CGRPmAb treatment in real-world clinical practice. In this review, we discuss the abstracts presented at the 49th Congress of the Japanese Headache Society (November 2021) and the 63rd Annual Meeting of the Japanese Society of Neurology (May 2022)． We identified 13 abstracts that have reported the efficacy and safety of CGRPmAb after greater than 1-month treatment with this agent. These results show that CGRPmAb decreased monthly migraine days and monthly headache days and minimized headache-induced disability without serious adverse effects.

  Objective : Migraine is a common disease with a high annual prevalence of 8.4%, and the degree of pain can be so severe that it significantly interferes with the affected individual’s quality of life. However, because migraines are common, many people might continue to work without informing anyone. In this study, we conducted a survey of the prevalence of headaches among hospital employees to examine their work environment.
  Subjects and Methods : Data collection was conducted using an anonymous questionnaire survey method for employees working at Tokyo Rosai Hospital. We recorded the prevalence of headaches, type of work, and work schedule of the employee. In those reporting headaches, we also recorded the number of missed work days due to headache, number of work days they intended to but were unable to take time off, their subjective ability to work when they had a headache, whether their supervisors and coworkers appeared understanding and sympathetic, interference with their daily lives, their headache triggers, whether they visited an outpatient clinic for headaches, and medication use and the type of medication.
  Results : Of the 566 respondents, 401 (70.8%) reported having headaches and 165 (29.2%) reported having no headaches. Among females, 348 had headaches and 104 had no headache, and among males, 53 had headaches and 61 had no headache, thereby being significantly more common in women than in men (p<0.01)．Compared to individuals in other occupations, nurses were significantly more likely to report headaches (p<0.01)．A total of 265 nurses (78.9%) reported having headaches and 71 nurses (21.1%) reported no headaches. With regard to consideration at work, 53.6% of the staff answered, “I don’t say anything, I keep quiet”. In addition, less than 5% of the respondents reported having ever left work early or missed work due to a headache.
  Conclusions : Although the ability to work is reduced by headaches, employees continue to quietly work while experiencing a headache and most are unlikely to leave work early or miss work. Even for common illnesses such as headache, presenteeism with strong symptoms and reduced work capacity is a problem. It is important to improve the understanding of headache and poor health in the workplace and to foster an environment that allows employees to take a break when required.

  Monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) have been introduced for the prevention of episodic and chronic migraine in Japan from April 2021. We describe real-world experience of galcanezumab in patients with migraine in a headache clinic. We treated 179 patients with migraine April 2021 to October 2021. We observed a mean reduction in monthly migraine days: MMD of mean － 8.0 days at week 24, patients achieving > 50% MMD reduction in 44%, >75% reduction in 19% and 100% reduction in 7.1% at week 24. Baseline migraine disability assessment: MIDAS 30.1 (6-100) reduced to 8.1(0-15) at week 24. Patient satisfaction with medication questionnaire-modified: PSMQ-M at week 4, week 12 and week 24 were 84.7%, 91.1% and 94.2% respectively. There are no severe adverse effect, except local pain or itching of injection site.
  Although limited experience, our retrospective findings suggest that treatment with galcanezumab is likely to lead to reductions in migraine days and high satisfaction with treatment in people with migraine.

  Functional gastrointestinal disorders (FGID) ，is a disorder in which abdominal symptoms occur paroxysmally without the presence of organic disease and is reported to be associated with migraine. Because of the lower recognition of FGID, it is not considered as a differential disease in patients, especially in the emergency room. Furthermore, making an accurate diagnosis of FGID is difficult because symptoms usually improve with rest. We correct the data retrospectively from the medical records at North Medical Center of Kyoto Prefectural University of Medicine, the only hospital providing emergency medical care in the area (population approx. 100,000, area 840 km²) ．Forty-two percent of migraine outpatients visited the emergency room for abdominal pain attacks in the past 10 years, and 83% of them did not need a hospitalization. Abdominal pain attack due to FGID may persist in relatively elderly migraine patients.

  The patient was a 47 year-old woman. History of present illness: The patient had participated in a clinical trial for erenumab. However, after the trial, the number of migraine days as well as the days requiring triptan increased to 14 per month. Consequently, acupuncture treatment was initiated. After three months of acupuncture, the number of migraine days decreased to four per month and the number of days requiring triptan decreased to five per month. Acupuncture may contribute to improvement of migraine exacerbations after the end of the erenumab trial.

  Headache is a relatively common adverse reaction after vaccination against the novel coronavirus disease (COVID-19) , but cluster headache rarely occurs. We experienced a patient with episodic cluster headache who had been attack-free for 10 years. However, on the day following the third dose of COVID-19 vaccine (mRNA-1273, Moderna) , his cluster headache relapsed. In this case, we considered the possibility that COVID-19 vaccination induced inflammation of the fluctuating trigeminovascular system. Based on our findings and those of other reported cases, we describe a hypothesis regarding the mechanism by which COVID-19 vaccines induce cluster headache as well as the relevant pathogenesis of cluster headache.