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Long-term treatment of chronic migraine with OnabotulinumtoxinA: efficacy, quality of life and tolerability in a real-life setting

  • Neurology and Preclinical Neurological Studies - Original Article
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Abstract

Botulinum toxin was shown to be effective in treatment of chronic migraine. We wanted to explore its efficacy and tolerability in chronic application under real-life conditions. For this, 27 consecutive patients (age 45.6 ± 10.8 years, 25 females, 2 males) received altogether 176 injection series (IS) with 189.7 ± 45.8MU onabotulinumtoxinA (Botox®) according to the PREEMPT scheme. During the study period altogether 6.5 ± 2.9 (min 4, max 13) IS were applied per patient (total treatment time of 73.1 ± 36.9 weeks). 96 % of the patients reported benefit. Monthly headache days were reduced from 18.9 ± 3.9 to 8.7 ± 4.5 (p < 0.001, −53.7 %), migraine days from 16.8 ± 4.9 to 7.4 ± 4.6 (p < 0.001, −55.1 %), autonomic days from 8.6 ± 7.5 to 2.7 ± 4.2 (p < 0.001, −71.9 %) and medication days from 14.2 ± 4.6 to 8.3 ± 4.2 (p < 0.001, −71.1 %). Health-related quality of life improved by 0.6–1.5 standard deviations (SD) (Short Form Health Survey), migraine-related quality of life by 1.4–2.0 SD (Migraine-Specific Quality of Life Questionnaire) and by 1.9 SD (Headache Impact Test), depression by 1.1 SD (Beck Depression Inventory). Subjective global clinical improvement was 2.6 ± 0.6 (Global Clinical Improvement Scale). All improvements were stable throughout the entire study period. Adverse effects were infrequent, mild and transient. Botulinum toxin provides highly effective and safe long-term treatment of chronic migraine.

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    Authors and Affiliations

    1. Department of Neurology, Movement Disorder Section, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

      Katja Kollewe, Claus M. Escher, Davood Fathi, Lejla Paracka & Dirk Dressler

    2. Max Planck Institute for Human Development, Berlin, Germany

      Dirk U. Wulff

    3. Brain and Spinal Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran

      Davood Fathi

    4. International Neuroscience Institute, Hannover, Germany

      Davood Fathi & Bahram Mohammadi

    5. Department of Neurology, University of Lübeck, Lübeck, Germany

      Bahram Mohammadi

    6. Department of Anaesthesiology, Pain Clinic, Hannover Medical School, Hannover, Germany

      Matthias Karst

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    1. Katja Kollewe
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    2. Claus M. Escher
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    Correspondence to Katja Kollewe.

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    Conflict of interest

    KK and BM received travel grants and honoraria for lectures from Allergan, Ipsen and Merz. LP received travel grants from Ipsen and Merz. MK received honoraria for lectures from Allergan. DD received honoraria for consultations from Allergan, Bayer, Eisai, IAB- Interdisciplinary Working Group for Movement Disorders, Ipsen, Merz, Syntaxin and UCB. He is shareholder of Allergan and holds several patents on Botulinum Toxins. CE, DUW and DF state that they have no conflict of interest.

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    K. Kollewe and C. M. Escher contributed equally.

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    Kollewe, K., Escher, C.M., Wulff, D.U. et al. Long-term treatment of chronic migraine with OnabotulinumtoxinA: efficacy, quality of life and tolerability in a real-life setting. J Neural Transm 123, 533–540 (2016). https://doi.org/10.1007/s00702-016-1539-0

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