OnabotulinumtoxinA Treatment in Chronic Migraine: Investigation of Its Effects on Disability, Headache and Neck Pain Intensity

Abstract

Neck disability and pain are frequently encountered problems in patients with chronic migraine (CM). The long-term stimuli of neurons in the trigeminocervical junction may explain this situation. OnabotulinumtoxinA (ONA) treatment is one of the proven treatments for CM; however, there is no study data on the efficacy of ONA treatment on neck disability and pain in CM patients. Therefore, we aimed to investigate the effect of ONA treatment on disability, neck pain and headache intensity in CM patients. One hundred thirty-four patients who met the inclusion criteria were included in the study. ONA treatment was administered at a dose of 195 U to 39 sites in total as per Follow-the-Pain PREEMPT protocol. The disability was evaluated with the Neck Disability Index and the Migraine Disability Assessment; pain intensity was evaluated with the Visual Analogue Scale; the monthly number of headache days were recorded; quality of life was evaluated with the Headache Impact Test. All assessments were recorded at baseline and 3 months after treatment. After the treatment, neck–migraine disabilities decreased from severe to mild for neck and moderate for migraine (p < 0.001). Neck pain and headache intensities decreased by almost half (p < 0.001). The median number of monthly headache days decreased from 20 days to 6 days (p < 0.000). The quality-of-life level decreased significantly from severe to substantial level (p < 0.001). According to our results, ONA treatment was effective in reducing neck-related problems in CM patients. Long-term follow-up results may provide researchers with more comprehensive results in terms of the treatment of chronic migraine–neck-related problems.

The Effect of OnabotulinumtoxinA on Headache Intensity and Number of Monthly Headache Days in Individuals with Chronic Migraine with Different Levels of Neck Disability

“…Considering the neck areas where OnabotulinumtoxinA treatment is applied, it is seen that it provides improvements in neck pain and disability, which are complaints of chronic migraine patients. In a hospital-based study, OnabotulinumtoxinA treatment was found to be effective for 3 months in reducing the intensity of NP, neck disability, intensity of headache, and number of monthly headache days and increasing the quality of life associated with CM [ 27 ]. The results of a systematic review reported that OnabotulinumtoxinA treatment in migraine was effective in reducing disability, headache intensity, frequency, and number of monthly headache days [ 35 ].…”

“…In a clinical study using this algorithm, neck and headache intensity, neck disability, and migraine disability decreased significantly in the third month after OnabotulinumtoxinA application in CM patients. In addition, the number of monthly headache days decreased from 20 to 6 [ 27 ]. Investigating the effects of the methods used in the treatment of CM on NP or disability, the intensity of headache, and the number of headache days per month will be useful for clinicians and researchers in predicting the patient’s condition.…”