Chronic Migraine and Medication Overuse Headache Worsening After OnabotulinumtoxinA Withdrawn Due to the Severe Acute Respiratory Syndrome-Coronavirus-2 Pandemic.

Carlo Baraldi,Valentina Favoni,Valeria Caponnetto,Raffaele Ornello,Sabina Cevoli,Simona Guerzoni,Simona Sacco,Giulia Pierangeli,Luca Pani

doi:10.3389/fneur.2021.647995

Abstract

Introduction: OnabotulinumtoxinA (BT-A) is a preventive treatment for chronic migraine (CM), which needs to be administered regularly by a trained clinician every 3 months. The spread of the severe acute respiratory syndrome coronavirus-2 pandemic has forced many patients to momentarily stop the scheduled BT-A injections. The goal of this study was to explore whether those patients experienced a worsening of their CM and, if any, the clinical predictors of migraine worsening after BT-A withdrawal.Methods: This was a retrospective, multicenter study. Patients' clinical data were obtained from their clinical documentation stored at each center. In particular, the following variables were collected: the mean number of headache days in the last month (NHD), the average number of painkillers taken in the last month (AC), the average number of days in which patients took, at least, one painkiller in the last month (NDM), the average intensity of migraine using the numeric rating scale (NRS) score in the last month, and the average score obtained at the six-item Headache Impact Test. The variables mentioned earlier were compared before and after BT-A withdrawal.Results: After BT-A suspension, there was a significant increase in the NHD (P = 0.0313, Kruskal–Wallis rank test), AC (P = 0.0421, Kruskal–Wallis rank test), NDM (P = 0.0394, paired t-test), NRS score (P = 0.0069, Kruskal–Wallis rank test), and six-item Headache Impact Test score (P = 0.0372, Kruskal–Wallis rank test). Patients who were not assuming other preventive treatments other than BT-A displayed similar results. Patients who experienced a >30% worsening in NHD after BT-A was withdrawn displayed a longer CM history (P = 0.001, Kruskal–Wallis rank test), a longer MOH duration (P = 0.0017, Kruskal–Wallis rank test), a higher AC value at the baseline (P = 0.0149, Kruskal–Wallis rank test), a higher NDM (P = 0.0024, t-test), and a higher average value of the NRS score (P = 0.0073, Kruskal–Wallis rank test).Conclusion: BT-A withdrawn during severe acute respiratory syndrome coronavirus-2 pandemic was associated with a general worsening in patients suffering from CM, hence the need to continue BT-A injection to avoid patients' worsening.

Highlights

OnabotulinumtoxinA (BT-A) is a preventive treatment for chronic migraine (CM), which needs to be administered regularly by a trained clinician every 3 months
This study explored the evolution of CM with and without medication overuse in those patients who were forced to momentarily withdraw the BT-A injections due to the SARSCOV-2 pandemic
The number of headache days (NHD), the analgesic consumption (AC), the number of days on medication (NDM), the numeric rating scale (NRS), and the six-items headache impact test (HIT-6) scores were significantly increased at the time of BT-A restart (Figure 1)

Summary

Introduction

OnabotulinumtoxinA (BT-A) is a preventive treatment for chronic migraine (CM), which needs to be administered regularly by a trained clinician every 3 months. According to the EHF guidelines, BT-A injections should be administered regularly every 3 months following the phase 3 trial evaluating migraine prophylaxis therapy scheme [7] It is not clear whether the effect of BT-A can last more than 3 months [8]. Because BT-A is the only preventive treatment for CM that needs a trained clinician to be administered [9], the spread of the severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2) pandemic has forced many patients to momentarily stop the scheduled BTA injections. This was due to the conversion of many hospital

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