COVID-19 pneumonia during long-term migraine prophylaxis with fremanezumab: a case report
Abstract
Migraine is a subtype of primary headache with a prevalence of 14–16% worldwide and is a leading cause of global disability under 50 years of age. Small molecule receptor antagonists (gepants), or monoclonal antibodies (mAbs) against calcitonin gene-related peptide (CGRP), have recently become available for migraine prophylaxis with proven efficacy. Although this new class of biologicals has shown a remarkable tolerability profile, their safety in the general population and under concomitant specific pathological conditions remains to be established. CGRP is highly represented in afferent nerve fibers in the lung, and seems to have a role in vasodilation of pulmonary vessels and in the attenuation of chronic hypoxia [1, 2]. On this basis, it has been hypothesized that CGRP receptor antagonism could be associated with cardiopulmonary adverse events in patients with COVID-19 [3]. Here, for the first-time, we report the outcome of a patient chronically treated (21 months) with the anti-CGRP antibody fremanezumab for migraine prophylaxis who developed mild COVID-19-related pneumonia. A 52-year-old female nurse had personal history of ovariectomy due to endometriosis, uterine polypectomy, head trauma without loss of awareness during adolescence, and no other relevant disorders. Family history positive for migraine (i.e., daughter) and no other relevant diseases. The patient reported headache insurgence at the age of six and fulfilled the current diagnostic criteria for high…
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