OnabotulinumtoxinA for Chronic Migraine: Latest Evidence


This is the Medscape Neurology Minute. I am Dr. Alan Jacobs. Researchers from the Albert Einstein College of Medicine in Bronx, New York, have published a study evaluating the effects of treatment with onabotulinumtoxinA on health-related quality of life and headache impact in adults with chronic migraine. The program consisted of a 24-week, double-blind phase, with two 12-week cycles followed by a 32-week open-label phase consisting of 3 cycles. Thirty-one injections of 5 units each, totaling 155 units, were administered to fixed sites. An additional 40 units could be administered as needed. They pooled results of 2 headache questionnaires assessing headache impact and migraine-specific quality of life. After random assignment, 688 patients received onabotulinumtoxinA and 696 received placebo. Mean scores at baseline on the headache-impact and quality-of-life questionnaires were comparable between the 2 groups, and 93% were severely affected based on impact scores ≥ 60. The investigators found that at 24 weeks, in comparison with placebo, onabotulinumtoxinA treatment significantly reduced headache impact scores and the proportion of patients with headache impact scores in the severe range at all timepoints, including week 24. Moreover, onabotulinumtoxinA treatments significantly improved all domains in the quality-of-life questionnaire at 24 weeks. The investigators concluded that treatment of chronic migraine with onabotulinumtoxinA is associated with significant and clinically meaningful reductions in headache impact and improvements in migraine-specific quality of life. This study was selected from Medscape Best Evidence. I'm Dr. Alan Jacobs.

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