Optimizing the long-term management of chronic migraine with onabotulinumtoxinA in real life

Cristina Tassorelli; Gioacchino Tedeschi; P Sarchielli; Luigi Alberto Pini; Licia Grazzi; Pierangelo Geppetti; Marina De Tommaso; Marco Aguggia; P Cortelli; Paolo Martelletti

doi:10.1080/14737175.2018.1419867

Optimizing the long-term management of chronic migraine with onabotulinumtoxinA in real life

Expert Rev Neurother. 2018 Feb;18(2):167-176. doi: 10.1080/14737175.2018.1419867. Epub 2017 Dec 27.

Authors

Cristina Tassorelli^{1

2}, Gioacchino Tedeschi³, P Sarchielli⁴, Luigi Alberto Pini⁵, Licia Grazzi⁶, Pierangelo Geppetti⁷, Marina De Tommaso⁸, Marco Aguggia⁹, P Cortelli^{10

11}, Paolo Martelletti¹²

Affiliations

¹ a Headache Science Center , National Neurological Institute C. Mondino , Pavia , Italy.
² b Department of Brain and Behavioral Sciences , University of Pavia , Pavia , Italy.
³ c Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy.
⁴ d Neurology Clinic , University Hospital of Perugia , Perugia , Italy.
⁵ e Center for Neuroscience and Neurotechnology, Polyclinic Hospital , University of Modena and Reggio Emilia , Modena , Italy.
⁶ f Headache and Neuroalgology Unit , Neurological Institute "C. Besta" IRCCS Foundation , Milan , Italy.
⁷ g Headache Center, Department of Health Sciences , University of Florence , Florence , Italy.
⁸ h Applied Neurophysiology and Pain Unit, SMBNOS Department, Polyclinic General Hospital , Bari Aldo Moro University , Bari , Italy.
⁹ i Headache Center, Neurology Department , Asti Hospital , Asti , Italy.
¹⁰ j Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy.
¹¹ k IRCCS Institute of Neurological Sciences of Bologna , Bellaria Hospital , Bologna , Italy.
¹² l Department of Clinical and Molecular Medicine, Sapienza University of Rome and Regional Referral Headache Center , Sant'Andrea Hospital , Rome , Italy.

PMID: 29280408
DOI: 10.1080/14737175.2018.1419867

Abstract

Management of chronic migraine is challenging. OnabotulinumtoxinA (OBT-A) is the only medication licensed for prevention of chronic migraine, and has been widely adopted in clinical practice. Limited data is available on its long-term use. Areas covered: Data from controlled trials are combined with available data on the long-term use of OBT-A in real-life studies, with information obtained in a recent survey among Italian headache centers, and the clinical experience of the authors. Six areas were identified as relevant to patients with chronic migraine: 1) definition of responders to OBT-A; 2) management of responders to OBT-A; 3) optimal timing of prophylaxis with OBT-A; 4) position of OBT-A in prevention of chronic migraine; 5) management of medication overuse, and 6) patient education. Expert commentary: This review provides an update on the latest evidence regarding the long-term use of OBT-A in chronic migraine and analyzes the critical issues in the decision-making process that emerge from the analysis of the literature and routine practice. A treatment algorithm is proposed for the adoption in the daily practice.

Keywords: Botox; chronic migraine; headache; migraine prophylaxis; onabotulinumtoxinA.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Acetylcholine Release Inhibitors / therapeutic use
Botulinum Toxins, Type A / therapeutic use*
Chronic Disease
Drug Administration Schedule
Humans
Migraine Disorders / drug therapy*
Migraine Disorders / prevention & control
Patient Education as Topic
Prescription Drug Overuse

Substances

Acetylcholine Release Inhibitors
Botulinum Toxins, Type A
onabotulinum toxin A