OSA screening before CGRP mAbs in chronic migraine

Area of Science:

• Neurology
• Sleep Medicine
• Public Health

Background:

• Chronic migraine is a disabling neurological disorder.
• Current treatments like CGRP monoclonal antibodies focus on headache frequency, often overlooking comorbidities.
• Obstructive sleep apnea (OSA) is common in chronic migraine patients and exacerbates disability.

Purpose of the Study:

• To propose routine screening for obstructive sleep apnea (OSA) in chronic migraine patients prior to initiating CGRP monoclonal antibody therapy.
• To highlight the potential of OSA diagnosis and management as a cost-effective, non-pharmacologic intervention.
• To advocate for integrating sleep health into chronic migraine management.

Main Methods:

• The study proposes a care pathway recommending routine OSA screening for chronic migraine patients.
• It emphasizes the low cost and accessibility of OSA diagnosis and management.
• The approach aims to complement existing biologic treatments by addressing a significant comorbidity.

Main Results:

• Integrating OSA screening and management into chronic migraine care is patient-centered.
• This approach addresses a reversible comorbidity, potentially improving cost-effectiveness and equity.
• Anecdotal evidence suggests OSA therapies like CPAP may reduce headache frequency and severity.

Conclusions:

• Inclusion of sleep health in chronic migraine management enhances patient-centered care.
• Addressing OSA can improve cost-effectiveness, equity, and health-related quality of life.
• Further randomized trials are needed to measure outcomes of headache, sleep quality, fatigue, and functional ability.