Abstract
Background. Migraine is a common disease that affects about 1 billion people worldwide. Factors affecting the limbic system play a major role in the migraine chronification. Dysfunction of the limbic system underlies many non-painful symptoms of migraine. Also there is an association between severe migraine and depression. Conditions such as misophonia and trypophobia are clinical markers indicating the development of limbic sensitization that accompanied chronic migraine.
Aim. The impact of limbic sensitization on the efficacy of fremanezumab therapy and depression in migraine patients.
Methods. A total of 80 patients with the established diagnosis of migraine and depression took part in the study. Fremanezumab 225 mg was administered monthly for 6 months. Сlinical interviewing and filling of Hamilton Depression Rating Scale, Central Sensitization Inventory, Trypophobia Questionnaire, and Misophonia Questionnaire were performed every month.
Results. A significant decrease in the headache frequency, depression, central sensitization, misophonia and trypophobia is observed with the steady increase of effect by month 3 of therapy and the effect persistence by month 6 of therapy is reported in patients with chronic migraine and depression. A significant decrease in the depression scores based on the Hamilton depression rating Scale is observed at 2, 3, and 6 months of treatment compared with baseline. There was a correlation between baseline misophonia and trypophobia scores and headache frequency, depression scores, and central sensitization scores. High baseline levels of misophonia and trypophobia were negative predictors of treatment efficacy.
Conclusion. Limbic system-mediated symptoms and comorbidities contribute to migraine chronification and affect patient quality of life, treatment satisfaction, and behavioral patterns. Screening for comorbidities is recommended for all patients with migraine.
Keywords: migraine, monoclonal antibodies, chronic migraine, depression, fremanezumab, CGRP, misophonia, trypophobia.
For citation: Timokhovich A.Yu., Berdnikova A.V., Latysheva N.V. The impact of limbic sensitization on the efficacy of fremanezumab therapy in migraine patients. Clinical review for general practice. 2025; 6 (8): 32–39 (In Russ.). DOI: 10.47407/kr2025.6.8.00655
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