BACKGROUND: Migraine prevention with erenumab and migraine induction by 
calcitonin gene-related peptide (CGRP) both carry notable individual variance. 
We wanted to explore a possible association between individual efficacy of 
anti-CGRP treatment and susceptibility to migraine induction by CGRP.
METHODS: Thirteen migraine patients, previously enrolled in erenumab anti-CGRP 
receptor monoclonal antibody trials, received CGRP in a double-blind, 
placebo-controlled, randomized cross-over design to investigate their 
susceptibility to migraine induction. A standardized questionnaire was used to 
assess the efficacy of previous antibody treatment. The patients were stratified 
into groups of high responders and poor responders. Primary outcomes were 
incidence of migraine-like attacks and area under the curve of headache 
intensity after infusion of CGRP and placebo. All interviews and experiments 
were performed in laboratories at the Danish Headache Center, Copenhagen, 
Denmark.
RESULTS: Ten high responders and three poor responders were included. CGRP 
induced migraine-like attacks in ten (77%) patients, whereof two were poor 
responders, compared to none after placebo (p = 0.002). The area under the curve 
for headache intensity was greater after CGRP, compared to placebo, at 0-90 min 
(p = 0.009), and 2-12 h (p = 0.014). The median peak headache intensity score 
was 5 (5-9) after CGRP, compared to 2 (0-4) after placebo (p = 0.004).
CONCLUSIONS: Patients with an excellent effect of erenumab are highly 
susceptible to CGRP provocation. If an association is evident, CGRP provocation 
could prove a biomarker for predicting antibody treatment efficacy.
TRIAL REGISTRATION: Retrospectively registered at clinicaltrials.gov with 
identifier: NCT03481400 .