{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T15:24:40Z","timestamp":1782314680649,"version":"3.54.5"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives\/Background<\/jats:title>\n                    <jats:p>Reimbursement criteria for anti\u2010calcitonin gene\u2010related peptide (CGRP) monoclonal antibodies (MAbs) typically rely on predefined reductions in monthly migraine days (MMD). However, this approach may fail to capture the full spectrum of treatment benefits, potentially leading to premature discontinuation in patients experiencing meaningful improvements in other parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective observational cohort study of prospectively collected data from a multicenter headache unit (Hospital Universitari de Bellvitge and Hospital de Viladecans, Barcelona, Spain) between December 2019 and September 2024. We included patients with migraine who initiated anti\u2010CGRP MAbs and who, at 6 months, would not meet institutional reimbursement criteria for response (\u226550% reduction in MMD or \u226530% reduction in MMD with \u22651\u2010point Headache Impact Test\u20106 improvement) but nonetheless continued treatment (\u201cfalse nonresponders\u201d). As a comparison group, we included patients who discontinued treatment within the first 6\u2009months due to lack of efficacy (\u201ctrue nonresponders\u201d). Outcome measures included headache frequency, disability, analgesic use, and overall treatment perception, assessed via headache diaries and patient\u2010reported outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 415 patients initiating MAbs, 106 were classified as false nonresponders. By month 6, 91.5% (95% confidence interval [CI] =\u200984.5\u201396.0) demonstrated improvements in at least one assessed outcome. Some of the most frequent benefits were Migraine Disability Assessment Score improvement (60.2%, 95% CI\u2009=\u200949.5\u201370.2), Patient Global Impression of Change score \u2265\u20095 (54.5%, 95% CI\u2009=\u200944.2\u201364.6), Headache Impact Test\u20106 reduction (44.1%, 95% CI\u2009=\u200934.3\u201354.3), medication\u2010overuse headache resolution (46.4%, 95% CI\u2009=\u200933.0\u201360.3), chronic to episodic migraine conversion (41.2%, 95% CI\u2009=\u200927.6\u201355.9), and a reduction in \u226550% of severe intensity days (29.3%, 95% CI\u2009=\u200919.4\u201341.0). Additionally, 82 patients continued treatment until 12\u2009months, when 18.3% (95% CI\u2009=\u200910.6\u201328.4) of those eventually met reimbursement criteria, underscoring the potential for late response. In contrast, 76 patients were classified as true nonresponders for discontinuing treatment within the first 6 months; among the 38 who reached the month 6 evaluation, only 65.8% (95% CI\u2009=\u200948.6\u201380.4) demonstrated improvement in at least one parameter. Compared to false nonresponders, they had a more severe baseline profile, including higher frequency and intensity, greater disability and analgesic use, poorer quality of life, higher depression rates, and more frequent prior onabotulinumtoxinA use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A substantial proportion of patients with migraine classified as nonresponders to anti\u2010CGRP MAbs at 6 months show measurable improvements beyond frequency reduction. These \u201cfalse nonresponders\u201d may benefit from continued treatment, highlighting the need for a more comprehensive assessment that includes intensity, analgesic use, disability, and quality of life to prevent premature discontinuation of potentially effective therapies. Conversely, patients with a worse baseline profile and limited early improvement may be appropriately identified as true nonresponders, justifying early treatment discontinuation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.70012","type":"journal-article","created":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T06:30:20Z","timestamp":1764397820000},"page":"172-182","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["False nonresponders to anti\u2010calcitonin gene\u2010related peptide monoclonal antibodies: A real\u2010world analysis beyond migraine frequency reduction"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8221-865X","authenticated-orcid":false,"given":"Albert","family":"Mu\u00f1oz\u2010Vendrell","sequence":"first","affiliation":[{"name":"Neurology Department, Headache Unit, Hospital Universitari de Bellvitge\u2010Institut d'Investigaci\u00f3 Biom\u00e8dica de Bellvitge Universitat de Barcelona  L'Hospitalet de Llobregat Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8135-4139","authenticated-orcid":false,"given":"Sergio","family":"Campoy\u2010D\u00edaz","sequence":"additional","affiliation":[{"name":"Neurology Department, Headache Unit, Hospital Universitari de Bellvitge\u2010Institut d'Investigaci\u00f3 Biom\u00e8dica de Bellvitge Universitat de Barcelona  L'Hospitalet de Llobregat Barcelona Spain"},{"name":"Neurology Department Hospital de Viladecans\u2010Institut d'Investigaci\u00f3 Biom\u00e8dica de Bellvitge  Viladecans Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5495-690X","authenticated-orcid":false,"given":"Patricia","family":"D\u00edaz\u2010Corta","sequence":"additional","affiliation":[{"name":"Neurology Department, Headache Unit, Hospital Universitari de Bellvitge\u2010Institut d'Investigaci\u00f3 Biom\u00e8dica de Bellvitge Universitat de Barcelona  L'Hospitalet de Llobregat Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidia","family":"Termens","sequence":"additional","affiliation":[{"name":"Neurology Department, Headache Unit, Hospital Universitari de Bellvitge\u2010Institut d'Investigaci\u00f3 Biom\u00e8dica de Bellvitge Universitat de Barcelona  L'Hospitalet de Llobregat Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaume","family":"Campdelacreu","sequence":"additional","affiliation":[{"name":"Neurology Department, Headache Unit, Hospital Universitari de Bellvitge\u2010Institut d'Investigaci\u00f3 Biom\u00e8dica de Bellvitge Universitat de Barcelona  L'Hospitalet de Llobregat Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Prat","sequence":"additional","affiliation":[{"name":"Neurology Department, Headache Unit, Hospital Universitari de Bellvitge\u2010Institut d'Investigaci\u00f3 Biom\u00e8dica de Bellvitge Universitat de Barcelona  L'Hospitalet de Llobregat Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi","family":"Sanahuja","sequence":"additional","affiliation":[{"name":"Neurology Department Hospital Arnau de Vilanova  Lleida Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0181-5335","authenticated-orcid":false,"given":"Mariano","family":"Huerta\u2010Villanueva","sequence":"additional","affiliation":[{"name":"Neurology Department, Headache Unit, Hospital Universitari de Bellvitge\u2010Institut d'Investigaci\u00f3 Biom\u00e8dica de Bellvitge Universitat de Barcelona  L'Hospitalet de Llobregat Barcelona Spain"},{"name":"Neurology Department Hospital de Viladecans\u2010Institut d'Investigaci\u00f3 Biom\u00e8dica de Bellvitge  Viladecans Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32504-8"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14032"},{"key":"e_1_2_11_4_1","first-page":"927","article-title":"Redefining migraine prevention: early treatment with anti\u2010CGRP monoclonal antibodies enhances response in the real world","volume":"95","author":"Caronna E","year":"2024","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/03331024211028966"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-024-07496-7"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/WCO.0000000000000689"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102417731348"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-021-01366-9"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.13383"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14031"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-021-00893-y"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsps.2024.101989"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/03331024231222923"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/03331024251320608"},{"key":"e_1_2_11_16_1","unstructured":"CatSalut.Acord de la CFT\u2010SISCAT del CatSalut sobre l'\u00fas d'erenumab fremanezumab i galcanezumab per al tractament profil\u00e0ctic de la migranya. Spain.2020."},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102417738202"},{"key":"e_1_2_11_18_1","unstructured":"Agencia Espa\u00f1ola de Medicamentos y Productos Sanitarios.Informe de Posicionamiento Terap\u00e9utico de erenumab en la profilaxis de migra\u00f1a.2019."},{"key":"e_1_2_11_19_1","unstructured":"Agencia Espa\u00f1ola de Medicamentos y Productos Sanitarios.Informe de Posicionamiento Terap\u00e9utico de galcanezumab en la profilaxis de migra\u00f1a.2019."},{"key":"e_1_2_11_20_1","unstructured":"Agencia Espa\u00f1ola de Medicamentos y Productos Sanitarios.Informe de Posicionamiento Terap\u00e9utico de fremanezumab en la profilaxis de migra\u00f1a.2020."},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/03331024241269735"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-021-01339-y"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102413497599"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-2982.2009.01852.x"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.12505_2"},{"issue":"4","key":"e_1_2_11_26_1","first-page":"133","article-title":"Chronic migraine with daily headache. Literature review","volume":"72","author":"Mart\u00ednez P\u00edas E","year":"2021","journal-title":"Rev Neurol"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-022-00415-0"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-021-01328-1"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-022-06265-8"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.15816"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000207292"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14903"}],"container-title":["Headache: The Journal of Head and Face Pain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/head.70012","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/head.70012","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/head.70012","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T05:32:22Z","timestamp":1773466342000},"score":1,"resource":{"primary":{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/10.1111\/head.70012"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,28]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/head.70012"],"URL":"https:\/\/doi.org\/10.1111\/head.70012","archive":["Portico"],"relation":{},"ISSN":["0017-8748","1526-4610"],"issn-type":[{"value":"0017-8748","type":"print"},{"value":"1526-4610","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,28]]},"assertion":[{"value":"2025-06-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}