Response to Galcanezumab in a Patient with Complex Neuropsychiatric Comorbidity: A Case Report
Abstract
Background: Migraine is a leading cause of disability worldwide and is frequently associated with psychiatric comorbidities that may influence pain perception and treatment response. Anti-CGRP monoclonal antibodies represent an effective preventive treatment, although response variability remains poorly understood, particularly in patients with complex neuropsychiatric profiles. Case Presentation: We report the case of a 49-year-old woman with migraine with a previously chronic course and psychiatric comorbidity, including bipolar disorder and obsessive-compulsive disorder, treated with galcanezumab. The clinical course was characterized by an "on-off-on" pattern, with marked worsening after treatment discontinuation and subsequent improvement after treatment reintroduction. Results: The patient presented with severe emotional distress (BDI-II = 59; STAI = 77-80), a very high self-reported burden of central sensitization-related symptoms (CSI = 100/100) and reduced performance on cognitive screening measures (MoCA = 19/30; BCSE = 18/58). MMPI-3 findings indicated a high level of self-reported psychological distress; however, substantial elevations in symptom-validity indicators required cautious interpretation of the substantive scales. Conclusions: This case illustrates that complex neuropsychiatric comorbidity and psychotropic polypharmacotherapy did not preclude an apparent clinical benefit from galcanezumab. Treatment discontinuation and reintroduction were temporally…
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