title: Effect of OnabotulinumtoxinA Injection on Depression in Chronic Migraine.
abstract: OBJECTIVE
  The current study retrospectively evaluated patient reported outcomes (PROs) collected before and after at least 2 sessions of onabotulinumtoxinA (onabot) injections for chronic migraine. Depression was assessed by the Patient Health Questionnaire-9.
  
  
  METHODS
  Chronic migraineurs receiving onabot were identified. In addition to the Patient Health Questionnaire-9 (PHQ9), the European Quality of Life (QOL), 5-Dimension (EQ-5D) (QOL), Headache Impact Test (HIT6), and Pain Disability Index (PDI) were reviewed across ≥2 consecutive onabot injections for 6-12 months. Paired t-tests on patient's questionnaire scores before and after treatment were performed. Analysis of the PHQ9 was restricted to patients with pretreatment scores ≥ 10 (moderate to severe depression). Change in PHQ9 was the primary outcome, and other PROs were also evaluated.
  
  
  RESULTS
  Four hundred twenty-nine patients met the inclusion criteria, and data were gathered from 2010 to 2014. Average age was 45 years, with 85.5% female, and 92.1% Caucasian. There were 127 patients with PHQ9 scores ≥10 at baseline. Their PHQ9 scores improved from 14.4 (high-moderate) pre-onabot to 11.3 (low-moderate) post-onabot (P <.0001, 95% CI = -4.2 to -2.1); PDI improved from 4.3 to 3.8 (P = .0078, 95% CI = -0.7 to -0.1); EQ-5D improved from 0.74 to 0.77 (P = .0078; 95%CI = 0.01 to 0.04); HIT6 improved from 63.3 to 60.5 (P <.0001, 95%CI = -3.4 to -2.2). For comparison, in the PREEMPT onabot regulatory trials, HIT6 changed from 66 to 61.2 after 5 onabot injections at 24 weeks, P < .001.
  
  
  CONCLUSIONS
  Onabot injections in chronic migraine patients statistically improved depression scores in patients beginning with at least moderate depression and improved scores in headache and quality of life. Onabot injections also decreased impact of headache on daily life.
authors.affiliation: Cleveland Clinic Headache Center, Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Kasra
authors.initials: K
authors.lastname: Maasumi
authors.affiliation: Department of Quantitative Health Sciences and Neurological Institute Center for Outcomes Research and Evaluation, Cleveland, OH, USA.
authors.forename: Nicolas R
authors.initials: NR
authors.lastname: Thompson
authors.affiliation: Cleveland Clinic Headache Center, Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Kriegler
authors.affiliation: Cleveland Clinic Headache Center, Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Stewart J
authors.initials: SJ
authors.lastname: Tepper
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002908:Chronic Disease; D003863:Depression / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy* / Q000523:psychology*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: HIT6; PHQ9; botox; chronic migraine; depression; onabotulinumtoxinA; patient reported outcomes