Multidisciplinary Translational Approach to Investigate Mechanisms Predictors & Prevention of Persistent PTH

Inclusion Criteria:

• Have a diagnosis of acute PTH attributed to mild traumatic injury to the head asdefined by the International Classification of Headache Disorders (ICHD-3).

• PTH onset 7-56 days prior to the time of enrollment

• Adults 18-70 years of age

• Willing to be randomized to either of the two clinical trial treatment arms

• Willing to maintain a headache diary

• Willing and able to return for follow-up visits

• 5 or more moderate or severe headache days during the 4-week run-in phase and anincrease of at least 2 moderate to severe headache days compared to pre-TBI and atleast a 30% increase

• At least 80% compliant with diary keeping during the 4-week run-in phase (i.e.,provides data on at least 80% of days)

Exclusion Criteria:

• Episodic tension-type headache, migraine, or other headaches with at least 4headache days/month on average over the 6 months prior to the mTBI resulting in PTH

• Chronic headache (i.e., at least 15 headache days/month for more than 3 months)within 12 months prior to the mTBI that led to the current PTH, including PPTH,chronic migraine, medication overuse headache, new daily persistent headache,hemicrania continua, chronic tension-type headache

• Diminished decision-making capacity that in the investigator's opinion wouldinterfere with the person's ability to provide informed consent and complete studyprocedures

• Started or changed dose of a headache preventive medication within the 3 monthsprior to screening

• Use of onabotulinumtoxinA in the head, neck or face region within 6 months ofscreening

• During the 6 months before screening, use of opioids or barbiturates on an averageof at least 4 days per month

• Subjects who underwent an intervention or used a device (e.g., nerve blocks,transcranial magnetic stimulation, vagal nerve stimulation, or electrical trigeminalnerve stimulation) for headache

• History of major psychiatric disorder such as schizophrenia and bipolar disorder

• History or evidence of any unstable or clinically significant medical condition,that in the opinion of the investigator, would pose a risk to subject safety orinterfere with the study evaluation, procedures, or completion

• History of positive neuroimaging findings that indicate a moderate or severe TBI

• Contraindications to magnetic resonance imaging, including, but not limited to (onlyan exclusion for patients participating in the brain MRI portion of this research):

1. Metal implants

2. Aneurysm clips

3. Severe claustrophobia

4. Implanted electronic device

5. Insulin or infusion pump

6. Cochlear/otologic/ear implant

7. Non-removable prosthesis

8. Implanted shunts/catheters

9. Certain intrauterine devices

10. Tattooed makeup

11. Body piercings that cannot be removed

12. Metal fragments

13. Wire sutures or metal staples

• Factors that reduce MR image quality and interpretability (only an exclusion forpatients participating in the brain MRI portion of this research):

1. Dental braces or other non-removable devices (e.g., retainers)

2. Prior brain surgery

3. Known brain MRI abnormality that in the investigator's opinion willsignificantly impact MRI data

• Sensory disorders that in the investigator's opinion might affect perception ofcutaneous thermal stimuli (e.g., peripheral neuropathy) (only an exclusion forpatients participating in the neurophysiology studies)

• Pregnancy

• Breastfeeding

• History of myocardial infarction, stroke, transient ischemic attack, unstableangina, coronary artery bypass surgery, or other revascularization procedures within 12 months prior to screening.

• Not willing to use a reliable form of contraception (for women of childbearingpotential) through 16 weeks after the last dose of erenumab. Acceptable methods ofbirth control include not having intercourse, hormonal birth control methods,intrauterine devices, surgical contraceptive methods, or two barrier methods (eachpartner must use a barrier method) with spermicide. A reliable form of contraceptionmust be started prior to or at the time of starting the run-in phase. Not being ofchildbearing potential is defined as any woman who is post-menopausal by history,defined as:

1. At least 55 years of age with cessation of menses for 12 or more months; OR

2. Younger than 55 years of age but no spontaneous menses for at least 2 years; OR

3. Younger than 55 years of age and spontaneous menses within the past 1 year, butcurrently amenorrheic (e.g., spontaneous or secondary to hysterectomy), ANDwith postmenopausal gonadotropin levels (luteinizing hormone andfollicle-stimulating hormone levels at least 40 IU/L) or postmenopausalestradiol level (less than 5 ng/dL) or according to the definition of "postmenopausal range" for the laboratory involved; OR

4. Underwent bilateral oophorectomy; OR

5. Underwent hysterectomy; OR

6. Underwent bilateral salpingectomy.

• Currently or within 90 days prior to screening: received treatment in another drugstudy or an investigational device study

• Has previously received any CGRP ligand or receptor targeted monoclonal antibody