title: Real-life data in 115 chronic migraine patients treated with Onabotulinumtoxin A during more than one year.
abstract: BACKGROUND
  OnabotulinumtoxinA (OnabotA) is effective in Chronic Migraine (CM) during first year of treatment and longer. In real clinical setting, CM patients with acute Medication Overuse (MO) or concurrently receiving oral preventatives are treated with OnabotA. We aim to assess evolution of CM patients beyond first year on OnabotA.
  
  
  METHODS
  Data were retrospectively collected in three headache units. We analyzed cases who had received at least five sessions of OnabotA according to PREEMPT protocol. We continued OnabotA therapy when a reduction of number of headache days of at least 30% was achieved.
  
  
  RESULTS
  We included 115 patients (98 females, 17 males) who completed 7.6 ± 2.3 (5-13) OnabotA procedures. Previously they had not responded to topiramate and, at least, one other preventative. Age at inclusion was 45.3 ± 12 (14-74) years, and latency between CM onset and OnabotA therapy was 43.1 ± 38.2 (6-166) months. At first OnabotA session 92 patients (80%) fulfilled MO criteria and 107 (93%) received a concurrent oral preventative. In 42 cases (36.5%) OnabotA dose was increased over 155 units. After first year in 57 out of 92 patients (61.9%) MO was discontinued. Among those receiving preventatives, in 52 out of 107 they were retired (48.6%). In 22 cases (19.1%) OnabotA administration was delayed to the fourth or fifth month and in 12 (10.4%) it was temporally stopped. Finally, in 18 patients (15.7%) OnabotA was discontinued due to lack of efficacy beyond first year of treatment.
  
  
  CONCLUSIONS
  Our results suggest that discontinuation of acute medication overuse and oral preventive therapies are achievable objectives in long-term using of OnabotA in CM patients.
authors.affiliation: Neurology Department, Hospital Universitario de Burgos, Burgos, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Aicua-Rapun
authors.affiliation: Neurology Department, Hospital Clínico Universitario de Valladolid, Avda. Ramón y Cajal 3, 47005, Valladolid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Martínez-Velasco
authors.affiliation: Neurology Department, Hospital Clínico Universitario, Valladolid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Rojo
authors.affiliation: Neurology Department, Hospital Universitario de Burgos, Burgos, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Hernando
authors.affiliation: Neurology Department, Hospital Clínico Universitario de Valladolid, Avda. Ramón y Cajal 3, 47005, Valladolid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Ruiz
authors.affiliation: Neurology Department, Hospital Clínico Universitario, Valladolid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Carreres
authors.affiliation: Neurology Department, Hospital Universitario de Burgos, Burgos, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Porqueres
authors.affiliation: Neurology Department, Hospital Clínico Universitario, Valladolid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Herrero
authors.affiliation: Neurology Department, Hospital Universitario de Burgos, Burgos, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Iglesias
authors.affiliation: Neurology Department, Hospital Clínico Universitario de Valladolid, Avda. Ramón y Cajal 3, 47005, Valladolid, Spain. gueneurol@gmail.com.
authors.forename: A L
authors.initials: AL
authors.lastname: Guerrero
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002908:Chronic Disease; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis* / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D011446:Prospective Studies; D012189:Retrospective Studies; D013223:Statistics as Topic / Q000639:trends*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Chronic Migraine; Medication overuse; OnabotulinumtoxinA; Preventatives; Real-life data