Abstract
Background Refractory chronic migraine (rCM) [1] is a debilitating neurological disorder, characterized by headache on ≥ 15 days per month for > 3 months, resistant to conventional symptomatic and/or prophylactic polytherapy. The effectiveness of the OnabotulinumtoxinA (OnabotA) was demonstrated in PREEMPT trials and approved in 2010 for CM treatment [2,3]. The prophylactic pharmacological actions of OnabotA include: a direct antinociceptiveanalgesic effect for primary peripheral afferent terminals by inhibiting release of nociceptive mediators (glutamate, substance P, CGRP) [4] and an indirect effect presumed to involve inhibition of peripheral and central sensitization in trigeminovascular neurons. The purpose of this study was to evaluate the efficacy, safety and tolerability of OnabotA as a prophylactic therapy in patients with rCM and observe the influence of the type of pain on the effectiveness of the treatment itself.
Highlights
Refractory chronic migraine [1] is a debilitating neurological disorder, characterized by headache on ≥ 15 days per month for > 3 months, resistant to conventional symptomatic and/or prophylactic polytherapy
Materials and methods We analyzed 76 patients (64 F), mean age 52 years (2382 yr) with Refractory chronic migraine (rCM) referred to the RRCCD of the Careggi Hospital, between 2011-2014
Written informed consent to publication was obtained from the patient(s)
Summary
Refractory chronic migraine (rCM) [1] is a debilitating neurological disorder, characterized by headache on ≥ 15 days per month for > 3 months, resistant to conventional symptomatic and/or prophylactic polytherapy. The effectiveness of the OnabotulinumtoxinA (OnabotA) was demonstrated in PREEMPT trials and approved in 2010 for CM treatment [2,3]. The prophylactic pharmacological actions of OnabotA include: a direct antinociceptiveanalgesic effect for primary peripheral afferent terminals by inhibiting release of nociceptive mediators (glutamate, substance P, CGRP) [4] and an indirect effect presumed to involve inhibition of peripheral and central sensitization in trigeminovascular neurons. The purpose of this study was to evaluate the efficacy, safety and tolerability of OnabotA as a prophylactic therapy in patients with rCM and observe the influence of the type of pain on the effectiveness of the treatment itself
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