Cochrane systematic review and meta-analysis of botulinum toxin for the prevention of migraine

Herd, Clare P; Tomlinson, Claire L; Rick, Caroline; Scotton, William; Edwards, Julie; Ives, Natalie; Clarke, Carl E; Sinclair, AJ

doi:10.1136/bmjopen-2018-027953

Cited by 89 publications

(82 citation statements)

References 39 publications

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“…Despite this, our findings at 12 weeks are similar to those of the recent metaanalysis by (Bruloy et al, 2019), wherein a mean difference in the change of migraine frequency of -0.23 (95 percent CI, -0.47 to 0.02; P = 0.08) was reported. Furthermore, our overall results are consistent with those of Herd et al (Herd et al, 2019) regarding changes in headache episodes per month. Intramuscular BTX-A for chronic migraine prevention is based on a previous study of its effectiveness in transient muscle relaxation (Burstein et al, 2014;Gooriah and Ahmed, 2015;Simpson, 2004).…”

Section: Discussionsupporting

confidence: 93%

“…These differences remained significant when considering specific complications, including headache, injection-site pain, musculoskeletal stiffness, myalgia, neck pain, paresthesias, muscle weakness, palpebral fissure, and blepharoptosis. Related studies (Herd et al, 2019) have also reported that BTX-A increases treatment-related AEs, but event types were reportedly mild and short-lived.…”

Section: Discussionmentioning

confidence: 89%

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Impact of the botulinum-A toxin on prevention of adult migraine disorders

Shen

Wang

2020

J. Integr. Neurosci.

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A systematic review of the impact of botulinum-A toxin as a therapeutic regimen for the management of adult migraine disorders is shown to that Botulinum-A toxin provides a more significant reduction in the number of headache episodes per month relative to placebo (MD:-0.61, 95% CI:-1.02 to-0.19). In subgroup analysis, botulinum-A toxin significantly reduced headache episodes per month relative to placebo for chronic migraine (MD:-1.68, 95% CI:-3.31 to-0.06), migraine (MD:-2.43, 95% CI:-4.08 to-0.77), and follow-up time in 16 weeks (MD:-2.19, 95% CI:-3.84 to-0.53). Statistical differences were not found in subgroup analyses of data relating to chronic migraine, episodic migraine, and other treatment course durations. An analysis of chronic and episodic migraine, botulinum-A toxin did not significantly differ from placebo in the proportion of patients achieving a fifty percent reduction in the number of headaches per month. In terms of patients' subjective reporting of headaches, botulinum toxin A conferred significant improvements when assessment questionnaires of migraine disability and migraine impact were analyzed. However, differences were not substantial with data from the 6-item headache impact test. This meta-analysis demonstrated that botulinum-A toxin as a therapeutic regimen improved the impact of chronic migraines after 16 weeks of therapy, although this was not the case for episodic migraine.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 89%

Impact of the botulinum-A toxin on prevention of adult migraine disorders

Shen

Wang

2020

J. Integr. Neurosci.

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“…The optimal management of CM associated with medication overuse is in fact controversial. Medication overuse is not a contraindication to BT-A treatment for CM and does not preclude its effectiveness [39,41]. However, detoxication prior to BT-A initiation may per se determine reversion of CM and may improve the efficacy [42].…”

Section: Discussionmentioning

confidence: 99%

Sustained response to onabotulinumtoxin A in patients with chronic migraine: real-life data

et al. 2020

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Background: Treatment with onabotulinumtoxin A (BT-A) is safe and effective for chronic migraine (CM). Several studies assessed possible predictors of response to treatment with BT-A, but there is little knowledge on the frequency and predictors of sustained response. The aim of this study was to evaluate sustained response to BT-A in patients with CM. Main body: In this prospective open-label study, 115 patients with CM and treated with BT-A were consecutively enrolled in two Italian headache centers and followed up for 15 months. Anytime responders were defined as those patients who achieved a ≥ 50% reduction in headache days during any three-month treatment cycle compared with the 3 months prior to initiation of BT-A treatment. Sustained responders were defined as those who achieved a ≥ 50% reduction in headache days within the third treatment cycle and maintained response until the end of follow-up. Non-responders were defined as those patients who never achieved a ≥ 50% reduction in headache days during the follow-up. Headache characteristics prior to BT-A treatment were assessed in order to evaluate their ability in predicting treatment response. The 115 enrolled patients (84.3% female; median age 50 years) had a median migraine duration of 30 years (interquartile range 22-38). At the end of follow-up, 66 patients (57.4%) were classified as anytime responders. Among the 51 patients who achieved a clinical response within the third month of treatment, 33 (64.7%) were sustained responders. Patients with sustained response had a lower CM duration (median 31 vs 65 months; P = 0.030) and a lower number of headache days (median 25 vs 30; P = 0.013) at baseline compared with nonresponders. Conclusions: About two thirds of patients who gain ≥50% response to BT-A within the third cycle of treatment maintain this positive response over time. More recent onset of CM and more headache-free days at baseline are associated with sustained response. We suggest not to delay preventive treatment of CM with BT-A, in order to increase the likelihood to achieve sustained clinical response.

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“…Several SRs examined the e cacy of acupuncture [11,42], BoNT-A [5,43], or topiramate [10,44,45] in migraine prophylaxis. Most of the SRs focused on the e cacy of the 3 treatments in episodic migraine; and none of them has compared the 3 treatments by combining both direct and indirect evidence.…”

Section: Discussionmentioning

confidence: 99%

“…As indicated by several systematic reviews and randomized controlled trials (RCTs), BoNT-A reduced the number of headache days and global pain intensity in patients with chronic migraine [3,4]. One systematic review indicated that BoNT-A had a relatively higher acceptance rate than other prophylactic agents [5], but the hypothesis was not statistically tested because of the lack of head-to-head comparisons. The e cacy of topiramate in the preventive treatment of chronic migraine was tested in several RCTs and meta-analyses [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of botulinum neurotoxin A, topiramate, and acupuncture in preventive treatment of chronic migraine: a network meta-analysis

Zheng

Huang

Chen

et al. 2020

Preprint

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Background Botulinum neurotoxin A (BoNT-A) was the primary choice for preventive treatment of chronic migraine. Topiramate and acupuncture showed promising effect for the condition, but their effectiveness relative to BoNT-A was rarely studied. We aimed to perform a network meta-analysis to compare the effectiveness and acceptability between BoNT-A, topiramate, and acupuncture.Methods We searched OVID Medline, Embase, the Cochrane register of controlled trials (CENTRAL), the Chinese Clinical Trial Register, and clinicaltrials.gov for randomized controlled trials (RCTs) that compared BoNT-A, topiramate, and acupuncture with any of them or placebo in the preventive treatment of chronic migraine. Two independent reviewers screened RCTs, extracted data, and assessed risk of bias. A network meta-analysis was performed by using a frequentist approach and a random-effects model. The primary outcomes were reduction in monthly headache days and monthly migraine days at week 12. Acceptability was assessed by adverse event rate. The effect size of the primary outcomes was measured by using standard mean difference (SMD).Results We included 15 RCTs (n = 2545). Eleven RCTs were at low risk of bias. The network meta-analyses (n = 2061) showed that acupuncture (2061 participants; SMD − 1.61, 95%CI -2.35 to -0.87) and topiramate(582 participants; SMD − 0.4, 95%CI -0.75 to -0.04) ranked the most effective in the reduction of monthly headache days and migraine days, respectively; but they were not significantly superior over BoNT-A. Topiramate caused the most treatment-related adverse events and the highest rate of dropouts owing to adverse events.Conclusions Topiramate and acupuncture were not superior over BoNT-A. In terms of acceptability and accessibility of treatments, BoNT-A was still the primary choice for preventive treatment of chronic migraine.

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Cochrane systematic review and meta-analysis of botulinum toxin for the prevention of migraine

Cited by 89 publications

References 39 publications

Impact of the botulinum-A toxin on prevention of adult migraine disorders

Impact of the botulinum-A toxin on prevention of adult migraine disorders

Sustained response to onabotulinumtoxin A in patients with chronic migraine: real-life data

Effectiveness of botulinum neurotoxin A, topiramate, and acupuncture in preventive treatment of chronic migraine: a network meta-analysis

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