In a consensus statement, experts consider treatment with CGRP-mAb in patients with MOH and recommend CGRP-mAb therapy for MOH. In the present study, patients with MOH experienced significant improvement in MHD 1 month after administration of CGRP-mAb (p<0.05) (Fig. of CGRP-mAb was 227.7 days; 1 month after administration, the MHD was 16.99.1 days. The switch in MHD was -5.7 days (22.7%), indicating significant improvement (p<0.05). Conclusion CGRP-mAb has been suggested as a preventive treatment for patients with MOH. Further investigation of the long-term efficacy of CGRP-mAb for MOH is needed. Keywords: calcitonin gene-related peptide monoclonal antibody, medication overuse, medication overuse headache, migraine Introduction Medication overuse headache (MOH) is categorized as a subtype of headache attributed to a material or its withdrawal, according to The International Classification of Headache Disorders, 3rd edition (ICHD-3) (1). MOH is usually a condition in which a patient with pre-existing main headache develops a new type of headache or marked exacerbation of a pre-existing primary headache associated with drug overuse. Most existing primary headache diagnoses are migraine, tension-type headache or both. The theory treatment for MOH has been to discontinue the causative drug by administering standard prophylactic drugs. In approximately 70% of patients, MOH enhances over 1-6 months after withdrawal therapy, but 30% of patients relapse within 4-6 years, most within 1 year after withdrawal (2). Calcitonin gene-related peptide (CGRP)-(receptor) monoclonal antibody (mAb) has been reported to reduce the frequency of medication overuse in patients with migraine (3-5). The present study investigated whether or not treatment with CGRP-mAb shows early effectiveness for individuals with MOH in Japan. Materials and Methods At our hospital, 69 patients with migraine experienced newly launched CGRP-mAb, and 34 included patients (49.3%) had MOH. We retrospectively examined the 34 patients who received preventive treatment with CGRP-mAb from June 2021 to October GLPG2451 2022. The effects after one month were analyzed using the mean quantity of headache days (MHD) as an index. We also conducted a comparative study among the three groups of CGRP-related antibody formulations. The types of CGRP-mAb used were galcanezumab (GAL) in 16 patients (47.0%), fremanezumab (FRE) in 10 (29.4%), and erenumab (ERE) in 8 (23.5%). The effects after one month were GLPG2451 compared among the three groups, mainly also using MHD as an index. The ICHD-3 was used to diagnose MOH (1). Data are expressed as the meanstandard deviation and were analyzed using a nonparametric analysis of variance (StatView; SAS, Cary, USA), with a p value <0.05 considered statistically significant. This study was conducted at a single center (Department of Neurology, Saitama Medical University or college). Patients were recruited from this specialized headache outpatient center (study approval number; 2022-005). Results Demographics Table shows the demographic and baseline characteristics of patients with MOH. In total, 69 patients with migraine experienced newly launched CGRP-mAb, and 34 patients experienced MOH (49.3%). The meanstandard deviation individual age was 4415.5 years old. The study populace included 24 women (70.6%). The mean disease period was 19.613.1 years. The types of migraine diagnosed were chronic migraine (CM) in 28 patients (82.4%) and migraine with aura (MWA) in 11 patients (32.4%). Prior to the introduction of CGRP-mAb, 20 patients (58.8%) used acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), and 27 patients (79.4%) used triptans. The average GLPG2451 number of doses of standard prophylactic drugs was 1.6. Four patients (11.8%) had depressive disorder as a coexisting factor that could lead to intractable headache. Table. Demographics and Baseline Disease Characteristics. Medication overuse GAL (N=16) FRE (N=10) ERE (N=8) Total (N=34)

Age, y43.6 (14.4)43.1 (18.4)50.7 (10.3)44 (15.5)Female, n (%)10 (62.5)8 (80)6 IDAX (75)24 (70.6)Disease duration18.7 (11.8)18.4 (16.8)25.4 (10.2)19.6 (13.1)CM, n (%)12 (75)10 (100)6 (75)28 (82.4)MWA, n (%)3 (18.6)5 (50)3 (37.5)11 (32.4)Depressive disorder, n (%)2 (12.5)1 (10)1 (12.5)4 (11.8)Acute headache medication, migraine non specific, n (%)9 (56.3)6 (60)5 (62.5)20 (58.8)Acute headache medication, migraine specific, n (%)12 (75.0)9 (90)7 (87.5)27 (79.4)Preventive medication, n1.8 (1.1)1.4 (0.7)1.6 (1.0)1.6 (1.0)Baseline period (MHD)18.9 (7.46)27.4 (5.36)21.6 (8.24)22 (7.7) Open in a separate window N: quantity of patients randomized. Data symbolize imply (SD) unless normally indicated CM: chronic migraine, MWA: migraine with.