2026 ECNP Congress

PS02-2168

Quality of sleep (QoS) in chronic migraine women during reproductive period treated with monoclonal antibodies – 6-months follow-up

Jelena Stojanov — A. Stojanov · University of Nis- Medical faculty, Clinic for Mental Health Protection, Nis, Serbia

2026 ECNP Congress

ОBJECTIVE: Chronic migraine (CM), affects 10% of adults worldwide, and it is up to 3 times more common in females during the reproductive period [1]. Sleep disturbances are frequent in patients with chronic migraine (CM). Quality od Sleep (QoS) is considered a valid indicator of the impact of irregularity in the sleep-wake cycle on the mental health of women in the reproductive period [2]. Monoclonal antibodies, such as fremanezumab, may offer better-tolerated and efficacious alternatives to traditional migraine pharmacological preventive therapies [3, 4]. The aim was to assess the quality of sleep (QoS) in women in their reproductive period with CM, during the follow-up period of 6 months, during which they were treated with fremanezumab once per month.

Methods

The study included 82 women in reproductive period with CM and 80 healthy age-matched control subjects. The exclusion criteria were the presence of other chronic illnesses (diabetes, asthma, hypertension, heart failure, renal and hepatic insufficiency), other sleep disorders (such as restless leg syndrome, sleep apnea…), other types of headache disorders, other neurological diseases, active infection, known history of any addiction. The study included the application of the Pittsburgh Sleep Quality Index (PSQI), Hamilton scales for the assessment of anxiety (HAM-A) and depression (HAM-D), and the 6-item Headache Impact Test (HIT-6). Questionnaires were assigned to patients only after carrying out a clinical examination and collecting epidemiological data. Diagnosis of CM is established according to the International Headache Society’s International Classification of Headache Disorders, established by a neurologist specializing in pain medicine and headaches. Subjects were tested before initiation of treatment, 2 weeks after the third dose, and 2 weeks after the sixth dose of fremanezumab. Fremanezumab was administered once a month at a dose of 225mg subcutaneously.

Results

The PSQI global score and all subscores in patients with CM were significantly higher than in the control group (p < 0.01). We noticed a statistically significant difference between the results in the PSQI global score between the first and third testing points (p < 0.01). Also, some subscores were statistically significantly better during the follow-up period. Patients with higher scores on HIT-6, HAM-A, and HAM-D had higher scores on PSQI. Higher scores on PSQI were also noticed in female patients, the elderly, and patients with higher body mass index (BMI) levels.

Conclusions

Sleep is one of the most important and basic requirements of every individual [5]. The results of our study show that the prevalence of sleep disturbance in CM patients is relatively high before starting the effective prophylactic treatment, which will reduce the number of attacks and monthly migraine days. Fremanezumab therapy had a significant beneficial influence on the QoS of CM women in their reproductive ages. High levels of sleep disturbance correlate with higher disease-related disability, anxiety, depression, and some characteristics of the disease. We strongly recommend to physicians and other clinicians to do regular screening and monitoring of QoS in chronic migraine women during reproductive period.

References

  1. Woldeamanuel YW, Cowan RP. Migraine affects 1 in 10 people worldwide featuring recent rise: a systematic review and meta-analysis of community-based studies involving 6 million participants. J Neurol Sci 2017;372:307—15.
  2. Lin YK, Lin GY, Lee JT, Lee MS, Tsai CK, Hsu YW, et al. Associations between sleep quality and migraine frequency. Med(United States). 2016;95:1—7.11.
  3. Ford JH, Schroeder K, Nyhuis AW, Foster SA, Aurora SK. Cycling Through Migraine Preventive Treatments: Implications for All-Cause Total Direct Costs and Disease-Specific Costs. J Manag Care Spec Pharm 2019;25(1):46-59.
  4. Dodick DW, Silberstein SD, Bigal ME, Yeung PP, Goadsby PJ, Blankenbiller T, Grozinski Wolff M, Yang R, Ma Y, Aycardi E. Effect of Fremanezumab Compared With Placebo for Prevention of Episodic Migraine: A Randomized Clinical Trial. JAMA 2018;319(19):1999 2008.
  5. Kim J, Cho SJ, Kim WJ, Yang KI, Yun CH, Chu MK. Excessive daytime sleepiness is associated with an exacerbation of migraine: A population-based study. J Headache Pain 2016;17(1):62.