Optimizing the long-term management of chronic migraine with onabotulinumtoxinA in real life

ABSTRACT

Introduction: Management of chronic migraine is challenging. OnabotulinumtoxinA (OBT-A) is the only medication licensed for prevention of chronic migraine, and has been widely adopted in clinical practice. Limited data is available on its long-term use.

Areas covered: Data from controlled trials are combined with available data on the long-term use of OBT-A in real-life studies, with information obtained in a recent survey among Italian headache centers, and the clinical experience of the authors. Six areas were identified as relevant to patients with chronic migraine: 1) definition of responders to OBT-A; 2) management of responders to OBT-A; 3) optimal timing of prophylaxis with OBT-A; 4) position of OBT-A in prevention of chronic migraine; 5) management of medication overuse, and 6) patient education.

Expert commentary: This review provides an update on the latest evidence regarding the long-term use of OBT-A in chronic migraine and analyzes the critical issues in the decision-making process that emerge from the analysis of the literature and routine practice. A treatment algorithm is proposed for the adoption in the daily practice.

KEYWORDS:

• Botox
• chronic migraine
• headache
• migraine prophylaxis
• onabotulinumtoxinA

Declaration of interest

C Tassorelli has participated in advisory boards for Allergan and ElectroCore; has lectured at symposia sponsored by Allergan; is PI or collaborator in clinical trials sponsored by Alder, electroCore, Eli Lilly, and Teva, and has received grants from the European Commission, Italian Ministry of Health, and Italian Ministry of University. L Grazzi has received travel grants and participated in an advisory board for Allergan, and is also a consultant for electroCore. P Geppetti has received consultancy fees from Allergan, Sanofi-Aventis, Novartis, Evidera, ElectroCore, and Pfizer, research grants from Chiesi Pharmaceuticals, and is principal investigator in randomized clinical trials sponsored by Eli Lilly, Novartis, and Teva. The remaining authors have no disclosures to declare. Medical writing/editorial assistance was provided to the authors by HPS, Health Publishing & Services, Srl Italy and funded by Allergan SpA, Italy at the request of the investigator.

Additional information

Funding

This paper was not funded.