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Before considering "onabotulinumtoxinA the patient
should have already taken other migraine prophylactics twice or thrice and must
stop the overused medication for migraine.
Chronic
migraine (CM) is a severe enervate disorder which affects about 2% of the
general population. Only two approaches have displayed the efficacy in treating
CM, one is OnabotulinumtoxinA, and the other is Topiramate. As compared to the
conventional treatment, OnabotulinumtoxinA shows some difficulties for headache
specialists who have not practiced injecting toxins before. As no European
Guidelines were present regarding the method to use OnabotulinumtoxinA and
therefore the European Headache Federation present with this guideline which
aimed to deliver recommendations for the use of OnabotulinumtoxinA in the
treatment of CM.
According
to the expert panel, the administration of OnabotulinumtoxinA should be as per
the PREEMPT injection rules, i.e. injecting 155 U–195 U to 31–39 sites each
12-weeks. The patients with less than 30% reduction in headache days per month
while the OnabotulinumtoxinA treatment was defined as non-responders. However,
while assessing response, other factors like disability, patient preferences,
and headache intensity should also be considered. The patients who do not
respond at the first two or three treatment cycles, the treatment should be
stopped in those patients. The evaluation four weeks before with the four weeks
following each treatment cycle should be conducted to determine the
OnabotulinumtoxinA response.
Further,
the patients who acquired a reduction to less than ten headache days per month
for three months should stop taking the OnabotulinumtoxinA treatment and
re-analysed 4–5 months after closing the OnabotulinumtoxinA treatment to
observe that the sufferer has not repeated CM. Questions associating
OnabotulinumtoxinA tolerability and efficacy could be explained based on
scientific evidence. The other recommendations principally relied on expert
evaluation. More analysis of the management of CM with OnabotulinumtoxinA needs
to be conducted.
The Journal of Headache and Pain
Guideline on the use of OnabotulinumtoxinA in chronic migraine: a consensus statement from the European Headache Federation
Lars Bendtsen et al.
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