Correction

Abstract

Both calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) and OnabotulinumtoxinA (botox) are used in the prevention of chronic migraines. However, it is not clear which is more effective overall. This review will compare the efficacy, side effects, cost-effectiveness, and other factors between CGRP mAbs and botox. We searched Pubmed and Google Scholar using the keywords migraines, CGRP mAbs, botox, efficacy, side effects, aura. All articles, including case-control/cohort studies, case series, case reports, randomized control trials, traditional/systematic reviews, were analyzed. CGRP mAbs and botox both reduce the frequency of migraines in patients. Patients have reported they decreased migraines' frequency and intensity in several studies after being given each medication. While CGRP mAbs are more recent medications, botox has been studied for more than a decade as a migraine preventative. Both drugs have minor short-term side effects, but some CGRP mAbs may cause persistent constipation too. CGRP mAbs are self-injected every month, and botox is physician-injected every three months, making it easier to stay compliant. While both medications are expensive, botox has a lower cost over time. Botox is more effective prophylaxis of migraines based on the articles that were reviewed. While both CGRP mAbs and botox are efficacious and tolerable, botox has been studied longer, has fewer side effects, is more costeffective, and is easier to comply with.

Applications of Ketogenic Diets in Patients with Headache: Clinical Recommendations

“…Hence, most of the preventive treatments are characterized by a relatively low responder rate (so, patients will require more preventive medications concomitantly), potentially dangerous drug–drug interactions, and several side effects that result in high rates of switching or discontinuing treatment [ 8 ]. The most recent biological treatments (OnabotulinumtoxinA and monoclonal antibodies against calcitonin-gene-related peptide (CGRP)) showed a better profile of safety, but they are not indicated for all patients and concerns have been raised about cost/effectiveness [ 9 ]. Moreover, these innovative treatments are not effective in all patients that try them.…”

Long‐term adherence, safety, and efficacy of repeated onabotulinumtoxinA over five years in chronic migraine prophylaxis

“…Apart from the obvious cost difference, there are some more arguments that could possibly be considered in favor of using anti‐CGRPs to CM patients who first failed treatment with BoNTA. Efficacy, expressed as the 50% response rate (reduction in monthly headache days) compared with placebo, is comparable between anti‐CGRPs and BoNTA, while there are no major safety issues with both interventions 44 . Based on lower dropout rates, tolerability seems to be better with anti‐CGRPs, 45 although one can argue that the application of BoNTA by a well‐trained injector every three months might facilitate better compliance with BoNTA, compared with anti‐CGRPs, which have to be self‐injected by the patient typically every month, thus potentially being painful at the injection site as a result of their fast rate dispersion into the subcutaneous tissue 46 .…”

“…Efficacy, expressed as the 50% response rate (reduction in monthly headache days) compared with placebo, is comparable between anti-CGRPs and BoNTA, while there are no major safety issues with both interventions. 44 Based on lower dropout rates, tolerability seems to be better with anti-CGRPs, 45 although one can argue that the application of BoNTA by a well-trained injector every three months might facilitate better compliance with BoNTA, compared with anti-CGRPs, which have to be self-injected by the patient typically every month, thus potentially being painful at the injection site as a result of their fast rate dispersion into the subcutaneous tissue. 46 In addition, there is evidence to support the beneficial effect of BoNTA injections at different sites, not just the forehead, in reducing the frequency and severity of comorbid psychiatric disorders, including depression and anxiety.…”

Management of chronic migraine

“…In the US, these drugs were approved starting in 2018 and priced at a similar annual cost to onabotulinumtoxin A, but their use was initially limited by insurance company coverage. 44 Elsewhere in the world, approval and availability were delayed. With time and increasing use, barriers to the use of these drugs are expected to diminish.…”