Abstract
The efficacy of onabotulinumtoxinA (OnaB-A) as a preventative treatment for chronic migraine, emerging fortuitously from clinical observation is now supported by class one evidence and over two decades of real-world clinical data. There is still limited ability to predict a clinically meaningful response to OnaB-A for individual patients, however. This review summarises briefly the proposed mechanism of OnaB-A in chronic migraine, the literature of predictors of clinical response, and recent developments in the field.
Highlights
Migraine is the most common disabling neurological condition, which globally in 2016 affected over one billion people, causing 45.1 million years lived with disability [1].Migraine may be classified as either episodic or chronic; patients with episodic migraine experience fewer than 15 headache days per month while patients with chronic migraine suffer 15 or more headache days per month, of which at least eight fulfil the InternationalClassification of Headache disorders (ICHD-3) criteria for migraine [2]
We review the use of OnaB-A in the treatment of chronic migraine, its efficacy, predictors of response, clinical considerations, and future directions
Quality of life measures of OnaB-A therapy have been assessed in multiple studies utilising several measures including the headache impact test (HIT-6), migraine disability assessment test (MIDAS) and migraine-specific quality of life questionnaire (MSQ)
Summary
Migraine is the most common disabling neurological condition, which globally in 2016 affected over one billion people, causing 45.1 million years lived with disability [1]. Classification of Headache disorders (ICHD-3) criteria for migraine [2]. 1–4% of the population meets the criteria for chronic migraine [3]. The treatment of chronic migraine includes the need for effective preventative treatment in order to reduce the number of attacks and thereby burden of the disease. OnabotulinumtoxinA (OnaB-A) has emerged as an effective preventative treatment of chronic migraine for many patients; predicting efficacy for individual patients remains challenging. We review the use of OnaB-A in the treatment of chronic migraine, its efficacy, predictors of response, clinical considerations, and future directions.
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