A Qualitative Study to Explore Patient Perspectives of Prophylactic Treatment with OnabotulinumtoxinA for Chronic Migraine

Wilderman, Igor; Tallarigo, Deborah; Pugacheva-Zingerman, Olga

doi:10.1007/s40122-021-00316-2

Cited by 4 publications

(9 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…migraine improvement in a subgroup of patients after menopause) [ 74 ]. Another reason to stop preventative therapies can occur in some countries when patients do not have the financial means to afford the treatment [ 75 ].…”

Section: Resultsmentioning

confidence: 99%

The sense of stopping migraine prophylaxis

et al. 2023

View full text Add to dashboard Cite

Introduction Migraine prophylactic therapy has changed over recent years with the development and approval of monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway. As new therapies emerged, leading headache societies have been providing guidelines on the initiation and escalation of such therapies. However, there is a lack of robust evidence looking at the duration of successful prophylaxis and the effects of therapy discontinuation. In this narrative review we explore both the biological and clinical rationale for prophylactic therapy discontinuation to provide a basis for clinical decision-making. Methods Three different literature search strategies were conducted for this narrative review. These include i) stopping rules in comorbidities of migraine in which overlapping preventives are prescribed, notably depression and epilepsy; ii) stopping rules of oral treatment and botox; iii) stopping rules of antibodies targeting the CGRP (receptor). Keywords were utilized in the following databases: Embase, Medline ALL, Web of Science Core collection, Cochran Central Register of Controlled Trials, and Google Scholar. Discussion Reasons to guide decision-making in stopping prophylactic migraine therapies include adverse events, efficacy failure, drug holiday following long-term administration, and patient-specific reasons. Certain guidelines contain both positive and negative stopping rules. Following withdrawal of migraine prophylaxis, migraine burden may return to pre-treatment level, remain unchanged, or lie somewhere in-between. The current suggestion to discontinue CGRP(-receptor) targeted mAbs after 6 to 12 months is based on expert opinion, as opposed to robust scientific evidence. Current guidelines advise the clinician to assess the success of CGRP(-receptor) targeted mAbs after three months. Based on excellent tolerability data and the absence of scientific data, we propose if no other reasons apply, to stop the use of mAbs when the number of migraine days decreases to four or fewer migraine days per month. There is a higher likelihood of developing side effects with oral migraine preventatives, and so we suggest stopping these drugs according to the national guidelines if they are well tolerated. Conclusion Translational and basic studies are warranted to investigate the long-term effects of a preventive drug after its discontinuation, starting from what is known about the biology of migraine. In addition, observational studies and, eventually, clinical trials focusing on the effect of discontinuation of migraine prophylactic therapies, are essential to substantiate evidence-based recommendations on stopping rules for both oral preventives and CGRP(-receptor) targeted therapies in migraine. Graphical Abstract

show abstract

Section: Resultsmentioning

confidence: 99%

The sense of stopping migraine prophylaxis

et al. 2023

View full text Add to dashboard Cite

show abstract

“…In their qualitative study of the patients’ perspective on the use of OBT-A in CM, Wilderman et al. [ 35 ] also found that participants had tried a wide range of treatments previously, for many years, but the treatments did not help to reach a satisfactory level of function [ 55 , 56 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the same vein, Wilderman et al. [ 35 ] described how patients were unsure how the treatment received could prevent CM, particularly because OBT-A is primarily known for its cosmetic effects.…”

Section: Discussionmentioning

confidence: 99%

“…Our participants had high expectations about the treatment’s potential to alleviate their pain. In Wilderman et al.’s study [ 35 ], patients who received OBT-A often had unrealistic expectations, ranging from very high expectations of recovery to no expectations at all. The expectations placed on treatment are influenced by what it means to be ‘effective’ to the patients.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Wilderman et al. [ 35 ] explored the experience of a mixed and heterogeneous group of patients with prophylactic OBT-A treatment for CM including both male and female participants. Accordingly, the aim of this study was to describe the experiences of women with CM treated with OBT-A.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Real-world experience of OnabotulinumtoxinA treatment in female patients with chronic migraine: a qualitative study using in-depth interviews

Palacios-Ceña,

Ordás-Bandera,

Casas-Limón

et al. 2023

Annals of Medicine

View full text Add to dashboard Cite

Background Chronic migraine (CM) causes great disability and affects an individual’s quality of life. OnabotulinumtoxinA (OBT-A, Botox®) was the first prophylactic treatment specifically indicated for CM. The aim of this study was to describe the experiences of women with CM treated with OBT-A. Materials and Methods The study design is a qualitative descriptive study. A purposeful sampling of 30 women (mean age, 42.7; standard deviation, 10.6) who had received at least two administrations of OBT-A for CM (PREEMPT protocol) was performed. Data collection included in-depth interviews and researchers’ field notes. A thematic analysis was carried out according to qualitative research guidelines. Results Five themes were identified: (a) A long way to go before Botox®, (b) First time hearing about the treatment and its expectations, (c) The administration of Botox®, (d) Treatment effects, and (e) Follow-up. Patients described a long history of treatment failures prior to the start of OBT-A treatment. Information about this migraine treatment came from the neurologist; following the information, patients had high expectations, including unrealistic expectations regarding the onset and duration of effect. They acknowledged fear of the injections and some discomfort due to the procedure. With treatment, participants reported better migraine control and an improvement in their quality of life. Follow-up had some barriers, such as delayed appointments for subsequent doses, but also strengths, such as effectiveness and few side effects. Conclusions Qualitative research offers insight into how patients with CM experience treatment with OBT-A. Our results highlight some relevant aspects that should be considered when providing OBT-A treatment.

show abstract

The Application of Botulinum Toxin in the Prophylactic Treatment of Migraine

Kuźmiuk,

Pawłowska,

Skorupa

et al. 2023

Polish Hyperbaric Research

View full text Add to dashboard Cite

Introduction: Migraine is a common disorder that affects about 2% of the general population, with a prevalence of 7% in men, 24% in women and 4% in children. Migraine is the fourth most disabling condition among women and the seventh most disabling worldwide. It is characterized by paroxysmal, throbbing headaches, often unilateral, accompanied by hypersensitivity to noise, light, nausea and vomiting. Migraine is divided into episodic and chronic, with chronic meaning headache for at least 15 days a month for more than 3 months, with 8 migraine days. Treatment includes non-pharmacological and pharmacological methods, but often ineffective and fraught with side effects. Chronic migraine can lead to significant disability. Material and methods: The purpose of this article is to discuss the treatment of migraine with botulinum toxin. Information was collected from the English-language databases Google Scholar, Scopus and PubMed. Results :Onabotulinum toxin A, approved for the treatment of migraine, works by blocking acetylcholine release at the synapse level, leading to reversible flaccid paralysis and blocking neurotransmitters such as CGRP. Injection sites include peri-cranial and neck muscles, allowing the toxin to be transported to the meninges and trigeminal ganglion. In recent years, injections near the cranial sutures have been preferred. BTX-A therapy has shown efficacy in reducing the frequency and severity of migraine pain, with fewer side effects compared to topiramate. Side effects, such as hematoma or ptosis, are rare and their frequency decreases with subsequent sessions. The cost of migraine treatment is high, but botulinum toxin reduces headache days and is cost-effective.

show abstract

A Qualitative Study to Explore Patient Perspectives of Prophylactic Treatment with OnabotulinumtoxinA for Chronic Migraine

Cited by 4 publications

References 38 publications

The sense of stopping migraine prophylaxis

The sense of stopping migraine prophylaxis

Real-world experience of OnabotulinumtoxinA treatment in female patients with chronic migraine: a qualitative study using in-depth interviews

The Application of Botulinum Toxin in the Prophylactic Treatment of Migraine

Contact Info

Product

Resources

About