title: Long-term treatment of chronic migraine with OnabotulinumtoxinA: efficacy, quality of life and tolerability in a real-life setting.
abstract: Botulinum toxin was shown to be effective in treatment of chronic migraine. We wanted to explore its efficacy and tolerability in chronic application under real-life conditions. For this, 27 consecutive patients (age 45.6 ± 10.8 years, 25 females, 2 males) received altogether 176 injection series (IS) with 189.7 ± 45.8MU onabotulinumtoxinA (Botox(®)) according to the PREEMPT scheme. During the study period altogether 6.5 ± 2.9 (min 4, max 13) IS were applied per patient (total treatment time of 73.1 ± 36.9 weeks). 96 % of the patients reported benefit. Monthly headache days were reduced from 18.9 ± 3.9 to 8.7 ± 4.5 (p < 0.001, -53.7 %), migraine days from 16.8 ± 4.9 to 7.4 ± 4.6 (p < 0.001, -55.1 %), autonomic days from 8.6 ± 7.5 to 2.7 ± 4.2 (p < 0.001, -71.9 %) and medication days from 14.2 ± 4.6 to 8.3 ± 4.2 (p < 0.001, -71.1 %). Health-related quality of life improved by 0.6-1.5 standard deviations (SD) (Short Form Health Survey), migraine-related quality of life by 1.4-2.0 SD (Migraine-Specific Quality of Life Questionnaire) and by 1.9 SD (Headache Impact Test), depression by 1.1 SD (Beck Depression Inventory). Subjective global clinical improvement was 2.6 ± 0.6 (Global Clinical Improvement Scale). All improvements were stable throughout the entire study period. Adverse effects were infrequent, mild and transient. Botulinum toxin provides highly effective and safe long-term treatment of chronic migraine.
authors.affiliation: Department of Neurology, Movement Disorder Section, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. kollewe.katja@mh-hannover.de.
authors.forename: Katja
authors.initials: K
authors.lastname: Kollewe
authors.affiliation: Department of Neurology, Movement Disorder Section, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Claus M
authors.initials: CM
authors.lastname: Escher
authors.affiliation: Max Planck Institute for Human Development, Berlin, Germany.
authors.forename: Dirk U
authors.initials: DU
authors.lastname: Wulff
authors.affiliation: Department of Neurology, Movement Disorder Section, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.|Brain and Spinal Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran.|International Neuroscience Institute, Hannover, Germany.
authors.forename: Davood
authors.initials: D
authors.lastname: Fathi
authors.affiliation: Department of Neurology, Movement Disorder Section, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Lejla
authors.initials: L
authors.lastname: Paracka
authors.affiliation: International Neuroscience Institute, Hannover, Germany.|Department of Neurology, University of Lübeck, Lübeck, Germany.
authors.forename: Bahram
authors.initials: B
authors.lastname: Mohammadi
authors.affiliation: Department of Anaesthesiology, Pain Clinic, Hannover Medical School, Hannover, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Karst
authors.affiliation: Department of Neurology, Movement Disorder Section, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Dressler
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000627:therapeutic use*; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy* / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A
keywords: Botox®; Botulinum toxin; Chronic migraine; Long-term treatment; OnabotulinumtoxinA; Real-life setting