Effects of OnabotulinumtoxinA on Allodynia and Interictal Burden of Patients with Chronic Migraine

Abstract

Background: We primarily aimed to ascertain whether treatment with ΟnabotulinumtoxinA (BoNTA) might influence the extent of the interictal burden and cutaneous allodynia in patients with chronic migraine (CM). Methods: Seventy CM patients, who received three consecutive cycles of BoNTA, were studied. The interictal burden was assessed with the Migraine Interictal Burden Scale (MIBS-4), while cutaneous allodynia was examined with the Allodynia Symptom Checklist (ASC-12) together with PI-NRS VAS to obtain hair brushing scores, and then these were compared from baseline (T0) to the last efficacy evaluation follow-up (T1). Efficacy outcomes, mostly mean headache days (MHD) and “Headache Impact Test” scores, were also assessed between T0 and T1. Results: BONTA improved the interictal burden, with a decrease in MIBS-4 scoring by an average of −7 at T1, compared to baseline (p < 0.001). The percentage of patients with a moderate/severe interictal burden was substantially decreased. Likewise, BoNTA reduced the extent of cutaneous allodynia, with a significant reduction in both the ASC-12 (1 vs. 6; p < 0.001) and PI-NRS VAS (1 vs. 5; p < 0.001) to hair brushing median scores at T1, compared to baseline. Reduced MHD rates were significantly associated with a smaller interictal burden at T1. The efficacy of BoNTA, with a significant reduction in MHD and HIT-6 scores at T1 compared to T0, was re-confirmed. Conclusions: BoNTA resulted in a statistically significant reduction in the interictal burden and also improved cutaneous allodynia. The reduction in ictal burden was associated with the down-scaling of the interictal burden. Hence, BoNTA improved the full spectrum of migraine impairment by diminishing the clinical expression of central sensitization.

Reducing the Impact of Headache and Allodynia Score in Chronic Migraine: An Exploratory Analysis from the Real-World Effectiveness of Anti-CGRP Monoclonal Antibodies Compared to Onabotulinum Toxin A (RAMO) Study

“…Our results on ASC-12 parallel those of a previous work on BoNT-A of our group, whose population included the subset of BoNT-A patients of the RAMO study from the Milan centre [ 41 ]. Conversely, other studies showed that BoNT-A in CM can be effective by influencing central sensitisation, by modulating nociceptive drive, and by reducing the overall burden of migraine [ 32 ], and the ASC-12 score decreased significantly in a similar treated population [ 42 , 43 ].…”

Beyond Pain Relief: Unveiling the Multifaceted Impact of Anti-CGRP/R mAbs on Comorbid Symptoms in Resistant Migraine Patients

“…Our group and others described a reduction in the allodynic symptoms in CM using onabotulinumtoxinA. The mechanisms of these preventive treatments could be convergent in reducing the peripheral and central excitability of the trigeminovascular/thalamic relays [ 78 , 79 ].…”

Beyond Pain: The Effects of OnabotulinumtoxinA Therapy on Sensitization and Interictal Symptoms in Chronic Migraine

“…Regarding interictal burden, a recent study conducted on 70 patients treated for three consecutive cycles (nine months) showed a significant reduction of interictal symptoms and cutaneous allodynia, assessed through MIBS-4 and ASC-12. Of interest, interictal burden improvement showed no relations to the persistence of allodynia; the authors concluded that this finding suggests a complex nature of interictal burden, which is not a simple sum of bothersome symptoms and that requires specific instruments to be assessed [77].…”