Abstract
Objective: To evaluate the early response of onabotulinumtoxinA as a treatment tool in patients with chronic migraine (CM) and medication overuse (MO).Patients and Methods: This is a retrospective study in patients with CM and MO who received two cycles of onabotulinumtoxinA infiltrations following PREEMPT protocol. We evaluated the efficacy of onabotulinumtoxinA in MO resolution, defined as less than 10 days/month of acute medication intake (triptans, opioids, and combinations) or 15 days/month (non-steroidal anti-inflammatory drugs - and simple analgesics). In addition, we analyzed changes in headache frequency, pain intensity, and headache-related disability (MIDAS scale). A multivariate analysis was carried out to identify factors independently related to MO resolution.Results: We included 139 consecutive patients with CM and MO. After 2 cycles of onabotulinumtoxinA, 73.4% had ≥50% reduction in acute medication intake and 57.6% achieved MO resolution. 7.9% of patients did not use any acute medication after treatment. Even though both MO-ongoing group and MO-resolution group improve in headache frequency, the reduction was significantly higher for the group which discontinued the use of acute medication after onabotulinumtoxinA treatment (p < 0.001). In this group, 73.0% reduced headache frequency ≥50%. Daily headache changed from 71.2 to 23.2% (p < 0.001). Both groups showed an improvement in pain intensity and in MIDAS score (p < 0.05). In the multivariate analysis we observed that MO resolution had an inverse association with medication intake at baseline (OR:0.294, p < 0.05) and a direct association with frequency (OR:20.455, p < 0.001) and MIDAS score (OR: 6.465, p < 0.05) improvements.Conclusion: OnabotulinumtoxinA has an early beneficial effect on the discontinuation of acute medication in a substantial proportion of patients with CM and MO. Therefore, onabotulinumtoxinA might be considered a therapeutic tool in CM with MO.
Highlights
Migraine is a prevalent medical condition and is the third cause of disability worldwide between 20 and 55 years of age [1, 2]
Chart review of the prespecified period identified a total of 139 patients treated with onabotulinumtoxinA who fulfilled ICHDIIIβ Chronic migraine (CM) criteria and medication overuse (MO) definition
Amongst some of the possible treatment strategies, onabotulinumtoxinA has been considered since the PREEMPT subgroup analysis of patients with MO showed its effectiveness compared to placebo [16]
Summary
Migraine is a prevalent medical condition and is the third cause of disability worldwide between 20 and 55 years of age [1, 2]. Chronic migraine (CM) affects around the 2% of the population and up to 50% of patients associate acute pain medication overuse (MO) [3, 4]. The great impact of MO in patients with headache remains a matter of concern since it is associated to poorer response to preventive treatment [7, 8] and worsening in quality of life and higher disability [9, 10]. As the majority of patients with MO suffer CM, it might be expected that onabotulinumtoxinA could be a useful treatment in acute medication discontinuation. The use of onabotulinumtoxinA for MO was not evaluated in the PREEMPT clinical trials development [13] nor it is mentioned in Spanish guidelines [14]
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