Treatment with Eptinezumab Reduces Brain Fog and Increases the Number of Good Days Per Month in Patients with Chronic Migraine in a Real-world Setting
Dawn Buse1, Seema Soni-Brahmbhatt2, Divya Asher2, Richard B. Lipton1
1Neurology, Albert Einstein College of Medicine, 2Lundbeck LLC

To evaluate the real-world effectiveness of eptinezumab on “brain fog” and the number of “good” days/month in adults with chronic migraine (CM).


Migraine-associated “brain fog” can occur as an ictal or interictal manifestation and negatively impact many aspects of life.

REVIEW, an observational, multi-site (4 tertiary headache centers), US-based study, was conducted to evaluate real-world experiences of patients with CM treated with eptinezumab for migraine prevention. Included patients (≥18 years) were diagnosed with CM and had completed ≥2 consecutive eptinezumab infusion cycles. Reported data are from a cross-sectional, post-eptinezumab patient survey. Patients ranked symptom bothersomeness and self-reported number of “good” days/month before and after eptinezumab. Patients reported if they ever experienced “brain fog,” defined as feeling confused, having difficulty learning or remembering, or having trouble speaking or reading before eptinezumab, and rated improvement after eptinezumab.
Ninety-four patients enrolled (female: 83%; mean age: 49 years; mean migraine diagnosis duration: 15 years). Before starting preventive treatment, “difficulty concentrating or thinking clearly” (78%) was ranked as the third most bothersome symptom following “head pain” and “head pain worsening with movement.” Eighty percent of patients reported ever experiencing “brain fog”. After eptinezumab, 86% reported some level of improvement and 63% reported moderate to complete improvement. Those who reported complete/very much improvement in “brain fog” had a 15-day increase in number of “good” days compared with a 1-day improvement in those whose “brain fog” did not improve. 
In this clinical-based study, “brain fog” was commonly reported (80%) and identified as a very/extremely bothersome symptom in patients with CM. Eighty-six percent reported some level of “brain fog” improvement after eptinezumab which was associated with more “good” days/month. Improvement in cognitive burden is an important target in CM and further research is needed to fully understand the impact of preventive therapies.