Abstract
Chronic migraine (CM) is a highly disabling primary headache. Botulinum toxin (onabotulinumtoxinA) is effective for treatment of CM, with ~ 50% of patients responding after 24 weeks. A response predictor would prevent unnecessary treatments. Inhibiting calcitonin gene related peptide (CGRP) release from trigeminal nociceptive fibres is one of the modes of acting discussed for onabotulinumtoxinA in CM. Therefore, we hypothesized that the response to triptans might predict response to onabotulinumtoxinA. Contrariwise, onabotulinumtoxinA treatment might affect triptan efficacy. 49 CM patients scheduled for their first onabotulinumtoxinA treatment were included. Before (T0) and three months after (T1) onabotulinumtoxinA treatment, patients rated triptan efficacy and indicated number of headache days/month. At T1, patients additionally rated onabotulinumtoxinA efficacy. Headache days/month were on average reduced by 7.1 ± 7.0 days from T0 to T1 (p < 0.001). Triptan efficacy ratings at T0 did not predict onabotulinumtoxinA efficacy ratings at T1 (p = 0.19) or reduction of headache days (p = 0.37). However, triptan efficacy significantly improved from T0 to T1 in onabotulinumtoxinA responders (p < 0.001) but not in non-responders (p = 1.00). Triptan efficacy did not predict response to onabotulinumtoxinA in CM. However, triptan efficacy increased after successful onabotulinumtoxinA treatment. This supports the hypothesis that efficacy of acute migraine treatment with triptans improves with effective migraine prophylaxis.
Highlights
Chronic migraine is a highly disabling primary headache disorder recognized as a complication of migraine
It has been reported that chronic migraine patients have increased calcitonin gene related peptide (CGRP) levels in peripheral blood, and more elevated CGRP levels are related to a better onabotulinumtoxinA response[11,12]
Triptans as well as onabotulinumtoxinA act by influencing the release of CGRP from trigeminal nerve fibres, we hypothesized that a good individual response to triptans in the acute migraine attack might predict a good response to onabotulinumtoxinA in the preventative treatment of chronic migraine
Summary
Chronic migraine is a highly disabling primary headache disorder recognized as a complication of migraine. Patients having more release of CGRP during their migraine attacks might react better to onabotulinumtoxinA treatment. It has been reported that chronic migraine patients have increased CGRP levels in peripheral blood, and more elevated CGRP levels are related to a better onabotulinumtoxinA response[11,12]. Triptans, which are the most effective acute migraine treatments available, exert part of their action by reducing CGRP release from trigeminal afferents, via agonistic action at 5-HT-1D r eceptors[13]. Triptans as well as onabotulinumtoxinA act by influencing the release of CGRP from trigeminal nerve fibres, we hypothesized that a good individual response to triptans in the acute migraine attack might predict a good response to onabotulinumtoxinA in the preventative treatment of chronic migraine. Before (T0) and three months after (T1) onabotulinumtoxinA treatment, patients rated triptan efficacy and indicated their number of headache days/month. The relation between triptan and onabotulinumtoxinA efficacy was tested
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