Abstract
Chronic migraine affects 2 % of the population and has substantial impact on quality of life and considerable burden on healthcare resources. 50–80 % patients with chronic migraine have excessive consumption of analgesic medications. Withdrawal of analgesics is often advised before commencing preventive treatments. However, some headache experts recommend preventive treatments alongside analgesic withdrawal. 434 patients with chronic migraine attending the Hull Headache Clinic who received OnabotulinumtoxinA as preventive treatment were stratified to those with or without analgesic overuse. Data was collected through a dedicated headache diary and analysed for headache and migraine days reduction and for an increment in headache-free days in the month post treatment. The data shows no difference in the therapeutic outcome in patients with or without analgesic overuse with substantial reduction in headache and migraine days and an increment in headache-free days in both groups in a real-life clinical setting. OnabotulinumtoxinA is equally effective in patients with chronic migraine with or without analgesic overuse.
Highlights
Chronic migraine (CM), defined as headache on ≥15 days/month for ≥3 months of which ≥8 days meet criteria for migraine with or without aura or responds to migraine-specific treatment (IHS 2013)
Excessive consumption of analgesics may lead to development of medication overuse headache (MOH), it remains uncertain whether this is a consequence or a cause of CM (Dodick and Freitag 2006; Negro and Martelletti 2011)
Demographics and baseline headache characteristics Of a series of 465 patients, full data on analgesic use was available on 434 patients (76 male, mean age 47.5; range 19–77, 358 females, mean age 44.9; range 18–91)
Summary
Chronic migraine (CM), defined as headache on ≥15 days/month for ≥3 months of which ≥8 days meet criteria for migraine with or without aura or responds to migraine-specific treatment (IHS 2013). A significant proportion of patients with CM have a high intake of analgesic medications and around 50–80 % of patients with CM attending specialist headache clinic have analgesic overuse (Deiner and Limmroth 2004; Bigal et al 2004). Many headache experts recommend withdrawal of the overused medication before commencing preventive treatment, this is not based on randomised, placebo-controlled trials (Hagen et al 2009) and for many patients in real life clinical practice, this is not a pragmatic solution. The issue of high prevalence of analgesic overuse in CM is acknowledged by the International Headache Society and allow their inclusion in clinical trials provided they are stratified (Silberstein et al 2008).
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