OnabotulinumtoxinA Injections for Patients with Chronic Migraine During the COVID-19 Pandemic

Abstract

Headaches are among the top prevalent conditions that physicians encounter in their daily practice. Migraine headaches affect nearly15% of the United States population (approximately 45 million).‎‎1,‎2 Over 50% of all patients with migraine report significant or severe impairment and disability.2 Migraine is the leading cause of years lived with disability among patients between ages 15 and 49 years old – the most productive years.‎‎3 According to the World Health Organization headache report, up to 4% of the world’s population experience chronic migraine (headaches occurring on at least 15 days per month with at least 8 of these headaches meeting migraine criteria).‎‎‎4 Approximately, 65% of patients with episodic migraine and 75% of patients with chronic migraine have missed family events and activities in the past month due to migraine-related impairment.‎‎5 Migraine also significantly impacts work-related activities. It has been estimated that 11% of patients with chronic migraine have been missing at least 1 day of work per week in the past 2 weeks‎.‎‎6 Based on migraine attack frequency and related disability, headache experts suggest offering prophylactic treatment options to patients with four migraine attacks per month or more. ‎‎7 Nevertheless, it has been estimated that only 26-29% of patients continue to adhere to their prophylactic treatment regimen at 6 months and only 17-20% continue to use their oral preventive medications at 12 months. ‎8,‎9 OnabotulinumtoxinA injection is an established FDA-approved therapy for chronic migraine prevention.