title: OnabotulinumtoxinA for hemicrania continua: open label experience in 9 patients.
abstract: BACKGROUND
  Hemicrania continua is a strictly unilateral, continuous headache, typically mild to moderate in severity, with severe exacerbations commonly accompanied by cranial autonomic features and migrainous symptoms. It is exquisitely responsive to Indomethacin. However, some patients cannot tolerate treatment, often due to gastrointestinal side effects. Therapeutic alternatives are limited and controlled evidence lacking.
  
  
  METHODS
  We present our experience of nine patients treated with OnabotulinumtoxinA for hemicrania continua. All patients were injected using the PREEMPT (Phase 3 REsearch Evaluating Migraine Prophylaxis Therapy) protocol for migraine.
  
  
  RESULTS
  Five of nine patients demonstrated a 50% or more reduction in moderate to severe headache days with OnabotulinumtoxinA with a median reduction in moderate to severe headache days of 80%. Patient estimate of response was 80% or more in five subjects. The median and mean duration of response in the five responders was 11 and 12 weeks (range 6-20 weeks). Improvements were also seen in headache-associated disability
  
  
  CONCLUSIONS
  OnabotulinumtoxinA adds a potential option to the limited therapeutic alternatives available in hemicrania continua.
authors.affiliation: Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery Queen Square, London, WC1N 3BG, UK. sarah.miller.12@ucl.ac.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Miller
authors.affiliation: Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery Queen Square, London, WC1N 3BG, UK. fanacorreia@gmail.com.|Department of Neurology, Centro Hospitalar do Porto, Oporto, Portugal. fanacorreia@gmail.com.
authors.forename: Fernando
authors.initials: F
authors.lastname: Correia
authors.affiliation: Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery Queen Square, London, WC1N 3BG, UK. susie.lagrata@uclh.nhs.uk.
authors.forename: Susie
authors.initials: S
authors.lastname: Lagrata
authors.affiliation: Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery Queen Square, London, WC1N 3BG, UK. m.matharu@uclmail.net.
authors.forename: Manjit S
authors.initials: MS
authors.lastname: Matharu
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D019233:Retreatment; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A; D007213:Indomethacin