OnabotulinumtoxinA at 195 UI may be effective in reducing the number of headaches per month and medication intake in patients with chronic migraine and medication overuse, according to a study published in Neurological Sciences.

Patients with medication overuse and treated with OnabotulinumtoxinA for chronic migraine (mean age, 47.2±9.4; onset of migraine, 19.4±11.6 years) were enrolled after undergoing a structured medication withdrawal program for 5 days. All patients received 5 OnabotulinumtoxinA therapy sessions every 3 months (195 UI per 31 sites).

The reduction in the number of headache days per month, number of symptomatic medications per month, and clinical indexes were evaluated. To determine whether treatment was associated with psychological variables, quality of life, disability, or catastrophizing attitude, patients were assessed with the MIDAS (Migraine Disability Assessment) questionnaire, the 6-item Headache Impact Test (HIT-6), and the Pain Catastrophizing Scale.

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Starting at the second session of OnabotulinumtoxinA, patients experienced a reduction in the number of days of headache per month (24.7±7.6 at baseline vs 14.7±11.2; P =.032) and a decrease in the number of medications taken per month (22.4±8.3 at baseline vs 14±8.4; P =.049). No side effects were reported. Rates of catastrophizing attitudes and disability were reduced, and overall improvements in quality of life reported, as indicated by the physical component summary score (28.2±10.5 at baseline vs 23.6±17.8), MIDAS score (63.3±52.1 at baseline vs 44.2±44.8), and HIT score (64.4±5.1 at baseline vs 63.4±8.4).

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The small sample size and the lack of a control group represent the primary limitations of the analysis.

“The application of OnabotulinumtoxinA is indicated in the early stage of the disease and this may result in better treatment outcome,” concluded the study authors.

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Grazzi L, Grignani E, Sansone E, et al. Onabotulinumtoxin A for chronic migraine with medication overuse: clinical results and changes in catastrophising attitude. Preliminary data. Neurol Sci. 2018;39(suppl 1):173-174.