Experience with onabotulinumtoxinA BOTOX in chronic refractory migraine: focus on severe attacksReport as inadecuate




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The Journal of Headache and Pain

, Volume 12, Issue 2, pp 235–238

First Online: 05 February 2011Received: 08 December 2010Accepted: 09 January 2011

Abstract

The objective of this study is to analyse our experience in the treatment of refractory chronic migraine CM with onabotulinumtoxinA BTA and specifically in its effects over disabling attacks. Patients with CM and inadequate response or intolerance to oral preventatives were treated with pericranial injections of 100 U of TBA every 3 months. The dose was increased up to 200 U in case of no response. The patients kept a headache diary. In addition, we specifically asked on the effect of BTA on the frequency of disabling attacks, consumption of triptans and visits to Emergency for the treatment of severe attacks. This series comprises a total of 35 patients 3 males, aged 24–68 years. All except three met IHS criteria for analgesic overuse. The number of sessions with BTA ranged from 2 to 15 median 4 and nine 26% responded reduction of >50% in headache days. However, the frequency of severe attacks was reduced to an average of 46%. Oral triptan consumption 29 patients was reduced by 50% from an average of 22 to 11 tablets-month. Those six patients who used subcutaneous sumatriptan reduced its consumption to a mean of 69% from 4.5 to 1.5 injections per month. Emergency visits went from an average of 3 to 0.4 per trimester −83%. Six patients complained of mild adverse events, transient local cervical pain being the most common. Although our data must be taken with caution as this is an open trial, in clinical practice treatment of refractory CM with BTA reduces the frequency of disabling attacks, the consumption of triptans and the need of visits to Emergency, which makes this treatment a profitable option both clinically and pharmacoeconomically.

KeywordsChronic migraine Chronic refractory migraine OnabotulinumtoxinA  Download fulltext PDF



Author: A. Oterino - C. Ramón - J. Pascual

Source: https://link.springer.com/



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