Guideline on the use of onabotulinumtoxinA in chronic migraine : a consensus statement from the European Headache Federation
Bendtsen, Lars (University of Copenhagen)
Sacco, Simona (University of L'Aquila. Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology)
Ashina, Messoud (University of Copenhagen)
Mitsikostas, Dimos (National and Kapodistrian University of Athens. 1st Department of Neurology, Aeginition Hospital)
Ahmed, Fayyaz (Hull York Medical School. Department of Neurosciences)
Pozo-Rosich, Patricia (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Martelletti, Paolo (Sapienza University. Department of Clinical and Molecular Medicine)
Universitat Autònoma de Barcelona
Hospital Universitari Vall d'Hebron

Fecha:	2018
Resumen:	OnabotulinumtoxinA is being increasingly used in the management of chronic migraine (CM). Treatment with onabotulinumtoxinA poses challenges compared with traditional therapy with orally administered preventatives. The European Headache Federation identified an expert group that was asked to develop the present guideline to provide recommendations for the use of onabotulinumtoxinA in CM. The expert group recommend onabotulinumtoxinA as an effective and well-tolerated treatment of CM. Patients should preferably have tried two to three other migraine prophylactics before start of onabotulinumtoxinA. Patients with medication overuse should be withdrawn from the overused medication before initiation of onabotulinumtoxinA if feasible, if not onabotulinumtoxinA can be initiated from the start or before withdrawal. OnabotulinumtoxinA should be administered according to the PREEMPT injection protocol, i. e. injecting 155 U-195 U to 31-39 sites every 12-weeks. We recommend that patients are defined as non-responders, if they have less than 30% reduction in headache days per month during treatment with onabotulinumtoxinA. However other factors such as headache intensity, disability and patient preferences should also be considered when evaluating response. Treatment should be stopped, if the patient does not respond to the first two to three treatment cycles. Response to continued treatment with onabotulinumtoxinA should be evaluated by comparing the 4 weeks before with the 4 weeks after each treatment cycle. It is recommended that treatment is stopped in patients with a reduction to less than 10 headache days per month for 3 months and that patients are re-evaluated 4-5 months after stopping onabotulinumtoxinA to make sure that the patient has not returned to CM. Questions regarding efficacy and tolerability of onabotulinumtoxinA could be answered on the basis of scientific evidence. The other recommendations were mainly based on expert opinion. Future research on the treatment of CM with onabotulinumtoxinA may further improve the management of this highly disabling disorder.
Nota:	Altres ajuts: The literature search was funded by a grant from the European Headache Federation.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Chronic migraine ; OnabotulinumtoxinA ; Management ; Guideline
Publicado en:	Journal of headache and pain, Vol. 19 (september 2018) , ISSN 1129-2377

DOI: 10.1186/s10194-018-0921-8
PMID: 30259200

10 p, 964.3 KB

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