Pattern of prescribing Onabotulinumtoxin A in chronic migraine patients

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Pattern of prescribing Onabotulinumtoxin A in chronic migraine patients

Migraine is a condition causing headache (affecting half one side or both sides of head) and may be accompanied by vomiting, nausea or sensitivity to light and/or sound, etc.  Chronic migraine refers to a severe headache lasting for 15 or more days a month. Chronic migraine is estimated to affect 2% of population and often needs preventive therapy. Onabotulinum toxin A (OnabotA) is considered to be an effective approach during the first year of treatment in chronic migraine patients.

To analyze the real-life experience of OnabotA in chronic migraine patients, a study was conducted in three different headache units. In this study, symptomatic medication overuse and concurrent prophylaxis therapy was focused.

The study selected different cases of chronic migraine who were treated with OnabotA in different headache units, located in three tertiary hospitals in Castilla-Leon (Spain). The data was collected and analyzed in five sessions of OnabotA according to the PREEMPT protocol. OnabotA was prescribed in patients failed to respond positively or could not tolerate topiramate or another neuromodulator, and beta-blockers. These drugs were administered at adequate doses and were found to be effective. Headache diary was also used to record the patients record. OnabotA was continued after achieving the 30% of reduction in headache.

After the analysis, it was observed that patients who completed OnabotA procedures, did not respond to topiramate. In first OnabotA session, 92 patients fulfilled the medication overuse (MO) criteria and 107 received the concurrent oral preventative. Further dose was increased in 42 cases over 155 units. Medication overuse was discontinued by 57 patients after first year. However, OnabotA administration was delayed to the fourth or fifth month and in 12 patients it was temporally stopped, while in 18 patients it was discontinued due to the lack of efficacy beyond first year of treatment.

Outcomes from the study suggested that the discontinuation of acute medication overuse and oral preventive therapies were achievable objectives in the long-term use of OnabotA. Efficacy in CM patients was shown to be consistent beyond first year of treatment. Though prolonged interruption of OnabotA was difficult to achieve, discontinuation of acute medication overuse and oral preventive therapy was considered with the reduction of frequency of procedures were realistic goals in real-life term using of OnabotA in chronic migraine patients.


The journal of headache and pain.

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Original title of article:

Real-life data in 115 chronic migraine patients treated with Onabotulinumtoxin A during more than one year


Aicua-Rapun, E. Martínez-Velasco, A. Rojo, A. Hernando, M. Ruiz, A. Carreres, E. Porqueres, S. Herrero, F. Iglesias and A. L. Guerrero

The journal of headache and pain.
Therapeutic, OnabotulinumtoxinA, Migraine, Head, Chronic, Neurotoxins, Retrospective Study, Efficacy
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