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Onabotulinumtoxin A for the management of chronic migraine in current clinical
practice: results of a survey of sixty-three Italian headache centers
#MMPMID28667550
Tassorelli C
; Aguggia M
; De Tommaso M
; Geppetti P
; Grazzi L
; Pini LA
; Sarchielli P
; Tedeschi G
; Martelletti P
; Cortelli P
J Headache Pain
2017[Dec]; 18
(1
): 66
PMID28667550
show ga
BACKGROUND: Chronic migraine is a complex clinical condition often undertreated.
Onabotulinumtoxin A (OBT-A) was approved in Italy in 2013 for symptom relief in
patients with chronic migraine who have failed, or do not tolerate, oral
prophylactic treatments. However, the impact of OBT-A in clinical practice
remains to be defined. METHODS: To investigate the current management of chronic
migraine with OBT-A in clinical practice, a web-based survey was conducted among
clinicians working in third-level headache centers across Italy. A 26-item
questionnaire was designed and developed by a group of 10 Italian headache
specialists to address the following issues: treatment paradigm and OBT-A
injection intervals, frequency of treatment and retreatment, definition of
responders/non-responders, satisfaction with treatment potential impact of early
treatment with OBT-A. Ninety-six headache centers were selected and contacted via
e-mail. The online survey was anonymous and carried out using a secure website.
RESULTS: Overall, 64 of the 96 centers (66.7%) completed the questionnaire. Most
centers (98.4%) had been using OBT-A for >1 year. OBT-A was administered
according to the PREEMPT paradigm in most centers (88.9%). While during the first
year of prophylaxis with OBT-A most clinicians (93.6%) repeated OBT-A treatment
every 3 months, as recommended, in the following years interval duration was
variable. Response to OBT-A was defined as a ? 50% reduction in the headache days
by 58.7% of the clinicians, and as a ? 30% reduction by 25.4% of them. Almost 60%
of the clinicians considered OBT-A as a long-lasting therapy, while for one-third
of them treatment could be discontinued in patients showing a benefit for
?6 months. According to 80% of the clinicians, early administration of OBT-A
after the onset of chronic migraine was associated with better outcomes, and
47.6% felt that OBT-A should be recommended as a first-line option. CONCLUSIONS:
This survey indicates that in third-level headache centers in Italy OBT-A is used
in good compliance with current recommendations. There is agreement about the
definition of response as a reduction in headache days by 30% to 50%. Additional
effort is required to define response to OBT-A and to establish optimal treatment
duration.
|Acetylcholine Release Inhibitors/*therapeutic use
[MESH]
|Adult
[MESH]
|Botulinum Toxins, Type A/*therapeutic use
[MESH]
|Female
[MESH]
|Guideline Adherence/*statistics & numerical data
[MESH]
|Humans
[MESH]
|Italy
[MESH]
|Male
[MESH]
|Migraine Disorders/*drug therapy
[MESH]
|Practice Guidelines as Topic
[MESH]
|Practice Patterns, Physicians'/*statistics & numerical data
[MESH]
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