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OnabotulinumtoxinA Wear‐off Phenomenon in the Treatment of Chronic Migraine
Author(s) -
MastersIsrailov Alina,
Robbins Matthew S.
Publication year - 2019
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.13638
Subject(s) - medicine , chronic migraine , migraine , anesthesia
Objective To evaluate the frequency and features of onabotulinumtoxinA (onabotA) wear‐off in chronic migraine (CM). Background Clinical experience suggests that patients with CM frequently perceive onabotA treatment duration <12 weeks, but this phenomenon has not been well explored. Methods This study was a retrospective chart review of patients (n = 143) with CM initiated on onabotA over a 2‐year period. Wear‐off was considered present with the phrase documented, a quantitative headache day increase, or increased use of abortive medications, bridging therapies or emergency department visits in the 6 weeks preceding the subsequent administration. Results Wear‐off was present in 90/143 patients (62.9%). Age, sex, medication overuse, psychiatric comorbidity, injector training level, and mean days between injections did not differ between the wear‐off and no wear‐off groups. Mean units injected per session in the wear‐off group until first documented wear‐off were significantly less vs no wear‐off group (166.0 ± 13.1 vs 173.4 ± 10.3, P = .0005). Wear‐off most commonly occurred 2‐4 weeks before the next injection (43.3%) and after the very first injection (40.0%). Intramuscular ketorolac injections (33.3%) and peripheral nerve blocks (25.6%) were the most common bridge therapies used in the wear‐off period. Conclusions Most patients with CM receiving onabotA experience wear‐off. Clinicians may consider increasing the units used from the treatment onset to reduce the frequent need for bridging therapies.