OnabotulinumtoxinA treatment for chronic migraine: experience in 52 patients treated with the PREEMPT paradigm

Abstract

OnabotulinumtoxinA (OnabotA) was approved for treatment of chronic migraine (CM) after publication of PREEMPT trials. Thus, we set out to evaluate the efficacy of OnabotA in a series of patients with CM treated according to the PREEMPT protocol.In May 2012 we began to offer OnabotA to patients with CM who did not respond to topiramate and at least one other preventive therapy (beta blocker and/or calcium channel antagonist). We prospectively recorded demographic data and the characteristics of migraine, and we assessed the modifications in monthly headache and migraine days, as well as the number of days of symptomatic medication and triptan intake.By September 2014 we had treated 52 patients (8 male, 44 female), whose age at treatment onset was 42.8 ± 12.7 years (range: 16–71) and age at migraine onset was 16.8 ± 7.8 years (3–32). In 43 of these patients (82.7%) symptomatic overuse of medication was observed at the onset of treatment. A total of 168 procedures were performed and after the first session, we observed a significant reduction in all the variables considered. Twelve (23.1%) patients failed to perceive a positive effect after the first procedure and it was not repeated in 4 of them. By contrast, there was a significant decreasing in all the variables evaluated compared to the baseline in the 39 patients that received a second series of injections.The use of OnabotA according to the PREEMPT paradigm is an effective treatment in patients with chronic migraine in a real-life setting.

OnabotulinumtoxinA in chronic migraine: predictors of response. A prospective multicentre descriptive study

“…Since the results from PREEMPT trials were published in 2010 many post-commercialization studies have borne out the efficacy of OnabotulinumtoxinA in CM [13][14][15][16][17][18][19]. A prospective study including 254 patients [16] with endpoints similar to our study showed lower efficacy rates, perhaps because their patients had already tried three different preventive treatments without response.…”

CGRP and PTX3 as Predictors of Efficacy of Onabotulinumtoxin Type A in Chronic Migraine: An Observational Study

“…Pedraza et al have published a study with 52 patients, and only 23.1% failed to perceive a positive effect after the first procedure. 38 Other studies found a much lower efficacy of treatment when considering number of migraine attacks. 23,39 This higher rate of response may be due to the inclusion of relatively young patients who had only tried two previous preventive treatments.…”

“…Previous studies have shown similar or lower rates of efficacy. Pedraza et al have published a study with 52 patients, and only 23.1% failed to perceive a positive effect after the first procedure . Other studies found a much lower efficacy of treatment when considering number of migraine attacks .…”

Botulinum toxin A (BT-A) versus low-level laser therapy (LLLT) in chronic migraine treatment: a comparison

“…Chronic migraine management includes acute medication optimization and a preventive pharmacological and non-pharmacological approach 5,6 . Current approved therapies are limited, with poor tolerability, refractory profiles and unfavorable costs 7 .…”

“…Botulinum toxin A acts on C-unit, but not on Aδ, meningeal nociceptors, inhibiting mechanical nociception to suprathreshold stimuli in peripheral trigeminal neurons, thus decreasing pain. It blocks acetylcholine release at the presynaptic nerve terminal, decreasing neuropeptides and releases other neurotransmitters from sensitized trigeminal endings 2,6,8 .…”