Abstract

Botulinum toxin was shown to be effective in treatment of chronic migraine. We wanted to explore its efficacy and tolerability in chronic application under real-life conditions. For this, 27 consecutive patients (age 45.6±10.8years, 25 females, 2 males) received altogether 176 injection series (IS) with 189.7±45.8MU onabotulinumtoxinA (Botox(®)) according to the PREEMPT scheme. During the study period altogether 6.5±2.9 (min 4, max 13) IS were applied per patient (total treatment time of 73.1±36.9weeks). 96% of the patients reported benefit. Monthly headache days were reduced from 18.9±3.9 to 8.7±4.5 (p<0.001, -53.7%), migraine days from 16.8±4.9 to 7.4±4.6 (p<0.001, -55.1%), autonomic days from 8.6±7.5 to 2.7±4.2 (p<0.001, -71.9%) and medication days from 14.2±4.6 to 8.3±4.2 (p<0.001, -71.1%). Health-related quality of life improved by 0.6-1.5 standard deviations (SD) (Short Form Health Survey), migraine-related quality of life by 1.4-2.0 SD (Migraine-Specific Quality of Life Questionnaire) and by 1.9 SD (Headache Impact Test), depression by 1.1 SD (Beck Depression Inventory). Subjective global clinical improvement was 2.6±0.6 (Global Clinical Improvement Scale). All improvements were stable throughout the entire study period. Adverse effects were infrequent, mild and transient. Botulinum toxin provides highly effective and safe long-term treatment of chronic migraine.

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