Botulinum toxin type A and acute drug costs in migraine with triptan overuse.
BACKGROUND
Patients with chronic migraine and medication overuse are significant consumers of health care resources.


OBJECTIVE
To determine whether botulinum toxin type A prophylaxis reduces the cost of acute migraine medications in patients with chronic migraine and triptan overuse.


METHODS
In this multicenter, open-label study, patients with chronic migraine (≥ 15 headache days/month) who were triptan overusers (triptan intake ≥ 10 days/month for ≥ 3 months) received botulinum toxin type A (95-130 U) at baseline and month three. Headache (HA) frequency and medication use were assessed with patient diaries, and headache-related disability by means of the MIDAS and Headache Impact Test-6 questionnaires.


RESULTS
Of 53 patients enrolled (mean age ± standard deviation, 46.5 years ± 8.4; 47 [88.7%] females), 48 (90.6%) completed the study at month six. Based on headache diaries, significant (P ≤ 0.0002) decreases from baseline were observed for days per month with headache/migraine, days with any acute headache medication use, days with triptan use, and triptan doses taken per month. A significant (P < 0.0001) increase from baseline in headache-free days per month was also observed. Prescription medication costs for acute headache medications decreased significantly, including significant reductions in triptan costs (mean reduction of -C$106.32 ± 122.87/month during botulinum toxin type A prophylaxis; P < 0.0001). At baseline, 78% of patients had severe disability (MIDAS score) and 86.8% had severe impact due to headache (HIT-6 scores); at month six, this decreased to 60% and 68%, respectively.


CONCLUSIONS
Botulinum toxin type A prophylactic therapy markedly decreased costs related to acute headache medication use in patients with chronic migraine and triptan overuse.
Department of Neurology, University of Ottawa, Ottawa, Canada.
Suzanne N
SN
Christie
Rose
R
Giammarco
Marek
M
Gawel
Gordon
G
Mackie
Jonathan
J
Gladstone
Werner J
WJ
Becker
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D019274:Botulinum Toxins, Type A / Q000191:economics* / Q000627:therapeutic use*; D004185:Disability Evaluation; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy* / Q000191:economics* / Q000517:prevention & control; D009465:Neuromuscular Agents / Q000191:economics / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014363:Tryptamines / Q000009:adverse effects* / Q000191:economics; D055815:Young Adult
D009465:Neuromuscular Agents; D014363:Tryptamines; D019274:Botulinum Toxins, Type A