Neurological Sciences

, Volume 37, Issue 11, pp 1779–1784 | Cite as

Effects of onabotulinumtoxinA treatment on efficacy, depression, anxiety, and disability in Turkish patients with chronic migraine

  • Bekir Enes Demiryurek
  • Devrimsel Harika Ertem
  • Atilla Tekin
  • Mustafa Ceylan
  • Yesim Guzey Aras
  • Belma Dogan Gungen
Original Article


Chronic migraine causes a serious labour loss and disability in the society and increases the risk of depression and anxiety by negatively affecting the quality of life. The purpose of this study was to investigate the effects of onabotulinumtoxinA (BoNT-A) treatment on efficacy before and after treatment in our cases with chronic migraine as well as on depression, anxiety and disability caused by migraine. According to the International Headache Classification (ICHD-III beta version), 60 adult patients who were diagnosed with chronic migraine were included in the study. A total of 155 IU BoNT-A treatment from 31 regions was administered in accordance with the protocol of PREEMPT study. Information about the characteristics of patients’ headaches, background and family history, drugs they used was recorded. At the baseline and in the first and third month after the BoNT-A injection, VAS scores, the number of both headache days and attacks, the headache duration, the frequency of application to emergency services and the intake of both analgesics and triptans during attacks were evaluated. MIDAS, BDI and BAI were evaluated at the baseline and in the third month after the BoNT-A injection. BoNT-A injection provided a significant decrease in the number of days and severity of headaches, MIDAS disability scores and psychiatric complaints in cases with chronic migraine who did not respond to prophylactic treatments in the third month of the treatment.


OnabotulinumtoxinA Chronic migraine Prophylactic treatment Disability Depression Anxiety 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Baykan B, Ertas M, Karlı N, Uluduz D, Uygunoglu U, Ekizoglu E, Kocasoy Orhan E, Saip S, Zarifoglu M, Siva A (2015) Migraine incidence in 5 years: a population-based prospective longitudinal study in Turkey. J Headache Pain 16:103CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Ertaş M, Siva A, Dalkara T, Uzuner N, Dora B, Inan L, Idiman F, Sarica Y, Selçuki D, Sirin H, Oğuzhanoğlu A, Irkeç C, Ozmenoğlu M, Ozbenli T, Oztürk M, Saip S, Neyal M, Zarifoğlu M, Turkish MIDAS group (2004) Validity and reliability of the Turkish Migraine Disability Assessment (MIDAS) questionnaire. Headache 44(8):786–793CrossRefPubMedGoogle Scholar
  3. 3.
    Headache Classification Committee of the International Headache Society (IHS) (2013) The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 33(9):629–808. doi:10.1177/0333102413485658 CrossRefGoogle Scholar
  4. 4.
    Minen MT, Begasse De Dhaem O, Kroon Van Diest A, Powers S, Schwedt TJ, Lipton R, Silbersweig D (2016) Migraine and its psychiatric comorbidities. J Neurol Neurosurg Psychiatry. doi:10.1136/jnnp-2015-312233 PubMedGoogle Scholar
  5. 5.
    Boudreau GP, Grosberg BM, McAllister PJ, Lipton RB, Buse DC (2015) Prophylactic onabotulinumtoxinA in patients with chronic migraine and comorbid depression: an open-label, multicenter, pilot study of efficacy, safety and effect on headache-related disability, depression, and anxiety. Int J Gen Med 18(9):79–86CrossRefGoogle Scholar
  6. 6.
    Ashina S, Serrano D, Lipton RB, Maizels M, Manack AN, Turkel CC, Reed ML, Buse DC (2012) Depression and risk of transformation of episodic to chronic migraine. J Headache Pain 13(8):615–624CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Bigal ME, Serrano D, Reed M, Lipton RB (2008) Chronic migraine in the population: burden, diagnosis, and satisfaction with treatment. Neurology 71(8):559–566CrossRefPubMedGoogle Scholar
  8. 8.
    Lucchesi C, Baldacci F, Cafalli M, Chico L, Lo Gerfo A, Bonuccelli U, Siciliano G, Gori S (2015) Evidences of reduced antioxidant activity in patients with chronic migraine and medication-overuse headache. Headache 55(7):984–991CrossRefPubMedGoogle Scholar
  9. 9.
    Dodick DW, Turkel CC, DeGryse RE, Aurora SK, Silberstein SD, Lipton RB, Diener HC, Brin MF, PREEMPT Chronic Migraine Study Group (2010) OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache 50(6):921–936CrossRefPubMedGoogle Scholar
  10. 10.
    Khalil M, Zafar HW, Quarshie V, Ahmed F (2014) Prospective analysis of the use of OnabotulinumtoxinA (BOTOX) in the treatment of chronic migraine; real-life data in 254 patients from Hull. J Headache Pain. 1(15):54. doi:10.1186/1129-2377-15-54 CrossRefGoogle Scholar
  11. 11.
    Lipton RB, Varon SF, Grosberg B, McAllister PJ, Freitag F, Aurora SK, Dodick DW, Silberstein SD, Diener HC, DeGryse RE, Nolan ME, Turkel CC (2011) OnabotulinumtoxinA improves quality of life and reduces impact of chronic migraine. Neurology 77:1465–1472CrossRefPubMedGoogle Scholar
  12. 12.
    Dirik EB (2013) The rare applications of botulinum toxin in neurology practices. Turkiye Klinikleri J Neurol Spec Top 6(4):39–45Google Scholar
  13. 13.
    Lipton RB, Stewart WF, Sawyer J, Edmeads JG (2001) Clinical utility of an instrument assessing migraine disability: the Migraine Disability Assessment (MIDAS) questionnaire. Headache 41(9):854–861CrossRefPubMedGoogle Scholar
  14. 14.
    Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571CrossRefPubMedGoogle Scholar
  15. 15.
    Beck AT, Epstein N, Brown G, Steer RA (1988) An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 56:893–897CrossRefPubMedGoogle Scholar
  16. 16.
    Ulusoy M, Sahin NH, Erkmen H (1998) Turkish version of the Beck Anxiety Inventory: psychometric properties. J Cogn Psychother 12:163–172Google Scholar
  17. 17.
    Binder WJ, Brin MF, Blitzer A, Pogoda JM (2000) Botulinum toxin type A (BOTOX) for treatment of migraine. Semin Cutan Med Surg 20(2):93–100CrossRefGoogle Scholar
  18. 18.
    Schaefer SM, Gottschalk CH, Jabbari B (2015) Treatment of chronic migraine with focus on botulinum neurotoxins. Toxins (Basel) 7:2615–2628CrossRefGoogle Scholar
  19. 19.
    Whitcup SM, Turkel CC, De Gryse RE, Brin MF (2014) Development of onabotulinumtoxinA for chronic migraine. Ann N Y Acad Sci 1329:67–80CrossRefPubMedGoogle Scholar
  20. 20.
    Matsuka Y, Kitamura Y, Spigelman I et al (2009) Botulinumtoxin type a (150 kDa) decreases exaggerated neurotransmitter release from trigeminal ganglion neurons and relieves neuropathy behaviors induced by infraorbital nerve constriction. Neuroscience 159:1422–1429CrossRefPubMedGoogle Scholar
  21. 21.
    Diener HC, Dodick DW, Aurora SK et al (2010) OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial. Cephalalgia 30:804–814CrossRefPubMedGoogle Scholar
  22. 22.
    Gazerani P, Staahl C, Drewes AM, Arendt-Nielsen L (2006) The effects of botulinum toxin type A on capsaicin-evoked pain, flare, and secondary hyperalgesia in an experimental human model of trigeminal sensitization. Pain 122:315–325CrossRefPubMedGoogle Scholar
  23. 23.
    Aoki KR (2005) Review of a proposed mechanism for the antinociceptive action of botulinum toxin type A. Neurotoxicology 26:785–793CrossRefPubMedGoogle Scholar
  24. 24.
    Yoldas TK, Donmez H, Solak EB, Colpak AI (2008) Demographic/clinical characteristics and MIDAS Scores of 103 consecutive migraine patients. Turkish J Neurol 6:388–393Google Scholar
  25. 25.
    Tombul K, Balcioglu I, Ertem DH, Bingol A, Goksan B, Uluduz D (2015) Personality profiles in patients with migraine type headache. NYS 53(2):30–36Google Scholar
  26. 26.
    Frampton JE (2012) OnabotulinumtoxinA (BOTOX®): a review of its use in the prophylaxis of headaches in adults with chronic migraine. Drugs 72(6):825–845CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2016

Authors and Affiliations

  • Bekir Enes Demiryurek
    • 1
  • Devrimsel Harika Ertem
    • 2
  • Atilla Tekin
    • 3
  • Mustafa Ceylan
    • 4
  • Yesim Guzey Aras
    • 1
  • Belma Dogan Gungen
    • 1
  1. 1.Neurology DepartmentSakarya University Education and Research HospitalSakaryaTurkey
  2. 2.Algology DepartmentIstanbul University Cerrahpasa Medical FacultyIstanbulTurkey
  3. 3.Psychiatri DepartmentAbant Izzet Baysal University Psychiatri Education and Research HospitalBoluTurkey
  4. 4.Neurology DepartmentErzurum Regional Training and Research HospitalErzurumTurkey

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